Stress habituation, body shape and cardiovascular mortality

Absent, but not glucocorticoid-modulated, corticotropin-releasing hormone (Crh) regulates anxiety-like behaviors in mice

The hypothalamic-pituitary-adrenal (HPA) axis is a well characterized endocrine response system. Hypothalamic Crh in the paraventricular nucleus of the hypothalamus (PVH) initiates HPA axis signaling to cause the release of cortisol (or corticosterone in rodents) from the adrenal gland. PVH-specific deletion of Crh reduces anxiety-like behaviors in mice. Here we report that manipulation of PVH Crh expression in primary adrenal insufficiency or by dexamethasone (DEX) treatment do not alter mouse anxiety behaviors. In Experiment 1, we compared wildtype (WT) mice to those with primary adrenal insufficiency ( Mrap KO) or global deletion of Crh ( Crh KO). We analyzed behaviors using open field (OF) and elevated plus maze (EPM), PVH Crh mRNA expression by spatial transcriptomics, and plasma ACTH and corticosterone after a 15-minute restraint test with ELISAs. EPM analysis showed Crh KO mice were less anxious than WT and Mrap KO mice, and Mrap KO mice had no distinguishing behavioral phenotype. In Experiment 2, we evaluated HPA axis habituation to chronically elevated Crh expression by comparing mice treated with 5-8 weeks of DEX with those similarly treated followed by DEX withdrawal for 1 week. All mice regardless of genotype and treatment showed no significant behavioral differences. Our findings suggest that reduced anxiety associated with low Crh expression requires extreme deficiency, perhaps outside of those PVH Crh neurons negatively regulated by glucocorticoids. If these findings extend to humans, they suggest that increases in Crh expression with primary adrenal insufficiency, or decreases with exogenous glucocorticoid therapy, may not alter anxiety behaviors via modulation of Crh expression.

Effects of Endurance Training on Antioxidant and Hormonal Status in Peripheral Blood of Young Healthy Men

(1) Background: Physical activity may cause an imbalance in the major functions of the human body. This study aimed to investigate the effects of endurance running training on the parameters of the antioxidant defense system (SOD, CAT, GPx, GR, GSH), LPO (malondialdehyde, MDA), and stress hormones (A, NA) in young healthy, previously untrained men. (2) Methods: The training program was as follows: 8 weeks of running, three times per week; the duration of a single session was 30-70 min, the intensity was twice a week in the so-called extensive endurance zone, and once a week in the anaerobic threshold zone. Blood samples were collected from the subjects, before and after the running program. (3) Results: The training program resulted in a significant increase in maximal oxygen consumption (p < 0.001). The activities of SOD, GPx, and GR also increased significantly (p < 0.05, p < 0.01, and p < 0.05, respectively), while CAT activity and GSH and MDA concentrations remained unchanged. The concentration of A decreased (p < 0.05), while the NA concentration increased significantly (p < 0.05). SOD, GPx, GR, and NA positively correlated with VO2max (p < 0.05, p < 0.001, p < 0.01, p < 0.05, respectively), while a negative correlation was detected between A and VO2max (p < 0.05). (4) Conclusions: These results indicate that there is no persistent oxidative stress in response to the applied 8-week running program, probably due to exercise-induced protective alterations in the antioxidant defense system. Furthermore, adaptations occurred at the hormonal level, making the organism more ready for a new challenge.

Correlation between uncertainty stress and depression among healthcare professionals in China: a nationwide cross-sectional survey

OBJECTIVE

This study investigated the correlation between uncertainty stress (US) and depression among healthcare professionals (HCPs) in China.

DESIGN, SETTINGS AND PARTICIPANTS

A cross-sectional online survey was conducted by recruiting HCPs from three provinces in China (central, eastern and western) through purposive sampling between 29 September 2022 and 18 January 2023. US was measured using the Life Stress Questionnaire and depression was measured using the Patient Health Questionnaire-9. In total, 2976 questionnaires were deemed valid.

PRIMARY AND SECONDARY OUTCOME

This study examined the prevalence of US and depression among HCPs in China; the correlating sociodemographic traits; and the correlation between US and depression.

RESULTS

The prevalence of US and depression among HCPs in China was 26.54% (790 out of 2976) and 71.63% (2132 out of 2976). Binary logistic analysis revealed that individuals with graduate degrees (OR: 1.83; 95% CI 1.07 to 3.11; p<0.05), central China (OR: 1.75; 95% CI 1.36 to 2.24; p<0.01), primary medical institutes (OR: 1.33; 95% CI 1.03 to 1.72; p<0.05), secondary medical institutes (OR: 1.30; 95% CI 1.01 to 1.68; p<0.05), an annual income of less than ¥50 000 (OR: 1.85; 95% CI 1.26 to 2.73; p<0.01) and an income range of ¥50 000-¥99 999 (OR: 1.49; 95% CI 1.10 to 2.03; p<0.05) were associated with a higher likelihood of US. The adjusted logistic regression model demonstrated that HCPs with higher US had a greater likelihood of depression (adjusted OR: 5.02; 95% CI 3.88 to 6.50; p<0.01). The increase in the US score was paralleled by an increased depression score (beta (B): 1.32; 95% CI 1.25 to 1.39; p<0.01).

CONCLUSION

These findings reveal a significant correlation between US and depression among HCPs and suggest that improving the management of US may help reduce the prevalence of depression among HCPs.

Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

Neural habituation during acute stress signals a blunted endocrine response and poor resilience

BACKGROUND

A blunted hypothalamic-pituitary-adrenal (HPA) axis response to acute stress is associated with psychiatric symptoms. Although the prefrontal cortex and limbic areas are important regulators of the HPA axis, whether the neural habituation of these regions during stress signals both blunted HPA axis responses and psychiatric symptoms remains unclear. In this study, neural habituation during acute stress and its associations with the stress cortisol response, resilience, and depression were evaluated.

METHODS

Seventy-seven participants (17-22 years old, 37 women) were recruited for a ScanSTRESS brain imaging study, and the activation changes between the first and last stress blocks were used as the neural habituation index. Meanwhile, participants' salivary cortisol during test was collected. Individual-level resilience and depression were measured using questionnaires. Correlation and moderation analyses were conducted to investigate the association between neural habituation and endocrine data and mental symptoms. Validated analyses were conducted using a Montreal Image Stress Test dataset in another independent sample (48 participants; 17-22 years old, 24 women).

RESULTS

Neural habituation of the prefrontal cortex and limbic area was negatively correlated with cortisol responses in both datasets. In the ScanSTRESS paradigm, neural habituation was both positively correlated with depression and negatively correlated with resilience. Moreover, resilience moderated the relationship between neural habituation in the ventromedial prefrontal cortex and cortisol response.

CONCLUSIONS

This study suggested that neural habituation of the prefrontal cortex and limbic area could reflect motivation dysregulation during repeated failures and negative feedback, which might further lead to maladaptive mental states.

Early life adversity jointly regulates body-mass index and working memory development

Previous work has proposed that balancing energy expenditure towards body and brain development in an optimal fashion results in a negative relationship between somatic and neurocognitive growth during development. An important issue, largely overlooked so far, is the extent to which this energetic trade-off is influenced by early life environmental factors. In this study, we estimated the association between neurocognitive (measured by working memory ability) and somatic (measured by body-mass index) developmental trajectories, while taking into account multiple dimensions of early life adversity. Results of our initial growth curve model were consistent with this brain-body trade-off in both girls and boys. In a subsequent model, we showed that early life adversity had positive associations with somatic and negative associations with neurocognitive growth trajectories, although the direct negative coupling between them remained consistent. Finally, a multidimensional adversity model, separating the effects of deprivation, threat and unpredictability, revealed that the dimension of deprivation-reflecting lack of access to resources and cognitive stimulation-contributed the most to both somatic and neurocognitive growth patterns. These results suggest that the way individuals balance energy between these two biological constructs during development is partly linked to environmental influences through phenotypic plasticity.

The Water Surrounding the Iceberg: Cultural Racism and Health Inequities

Policy Points Cultural racism-or the widespread values that privilege and protect Whiteness and White social and economic power-permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the "tip of the iceberg," whereas structural and institutional racism represent its base. This paper advances cultural racism as the "water surrounding the iceberg," allowing it to float while obscuring its base. Considering the fundamental role of cultural racism is needed to advance health equity.

CONTEXT

Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism.

METHODS

We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities.

FINDINGS

Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course.

CONCLUSIONS

More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence-based policy interventions to reduce cultural racism and promote health equity.

Genetic polymorphisms in the serotonin, dopamine and opioid pathways influence social attention in rhesus macaques (Macaca mulatta)

Behaviour has a significant heritable component; however, unpicking the variants of interest in the neural circuits and molecular pathways that underpin these has proven difficult. Here, we present a comprehensive analysis of the relationship between known and new candidate genes from identified pathways and key behaviours for survival in 109 adult rhesus macaques (Macaca mulatta). Eight genes involved in emotion were analysed for variation at a total of nine loci. Genetic data were then correlated with cognitive and observational measures of behaviour associated with wellbeing and survival using MCMC-based Bayesian GLMM in R, to account for relatedness within the macaque population. For four loci the variants genotyped were length polymorphisms (SLC6A4 5-hydroxytryptamine transporter length-polymorphic repeat (5-HTTLPR), SLC6A4 STin polymorphism, Tryptophan 5-hydroxylase 2 (TPH2) and Monoamine oxidase A (MAOA)) whilst for the other five (5-hydroxytryptamine receptor 2A (HTR2A), Dopamine Receptor D4 (DRD4), Oxytocin receptor (OXTR), Arginine vasopressin receptor 1A (AVPR1a), Opioid receptor mu(μ) 1 (OPRM1)) SNPs were analysed. STin genotype, DRD4 haplotype and OXTR haplotype were significantly associated with the cognitive and observational measures of behaviour associated with wellbeing and survival. Genotype for 5-HTTLPR, STin and AVPR1a, and haplotype for HTR2A, DRD4 and OXTR were significantly associated with the duration of behaviours including fear and anxiety. Understanding the biological underpinnings of individual variation in negative emotion (e.g., fear and anxiety), together with their impact on social behaviour (e.g., social attention including vigilance for threat) has application for managing primate populations in the wild and captivity, as well as potential translational application for understanding of the genetic basis of emotions in humans.

Dampened psychobiological responses to stress and substance use in adolescence

Substance use increases throughout adolescence, and earlier substance use may increase risk for poorer health. However, limited research has examined whether stress responses relate to adolescent substance use, especially among adolescents from ethnic minority and high-adversity backgrounds. The present study assessed whether blunted emotional and cortisol responses to stress at age 14 related to substance use by ages 14 and 16, and whether associations varied by poverty status and sex. A sample of 277 Mexican-origin youth (53.19% female; 68.35% below the poverty line) completed a social-evaluative stress task, which was culturally adapted for this population, and provided saliva samples and rated their anger, sadness, and happiness throughout the task. They also reported whether they had ever used alcohol, marijuana, cigarettes, and vaping of nicotine at age 14 and again at age 16. Multilevel models suggested that blunted cortisol reactivity to stress was associated with alcohol use by age 14 and vaping nicotine by age 16 among youth above the poverty line. Also, blunted sadness and happiness reactivity to stress was associated with use of marijuana and alcohol among female adolescents. Blunted stress responses may be a risk factor for substance use among youth above the poverty line and female adolescents.

The Role of the Stress Response in Metabolic Dysfunction-Associated Fatty Liver Disease: A Psychoneuroendocrineimmunology-Based Perspective

The novel term metabolic dysfunction-associated fatty liver disease (MAFLD), which has been proposed to describe the major cause of hepatic disease, pinpoints the coexistence of multiple metabolic disturbances and liver steatosis, giving rise to different phenotypic manifestations. Within the psychoneuroendocrineimmunological (PNEI) network that regulates body-mind interactions, the stress response plays a pervasive role by affecting metabolic, hormonal, immune, and behavioral balance. In this perspective, we focus on chronic psychosocial stress and high levels of cortisol to highlight their role in MAFLD pathogenesis and worsening. From a PNEI perspective, considering the stress response as a therapeutic target in MAFLD allows for simultaneously influencing multiple pathways in the development of MAFLD, including dysmetabolism, inflammation, feeding behaviors, gut-liver axis, and dysbiosis, with the hope of better outcomes.

Effects of negative emotions and information perceived value on residents' risk perception during the COVID-19 pandemic: An empirical survey from China

Background

The COVID-19 pandemic has spread rapidly and heavily hit the globe, and the mutation and transmission speed of the coronavirus have accelerated so that the world is still in danger. Thus, this study aims to investigate the participants' risk perception and explore the associations of risk perception of COVID-19 with negative emotions, information value perception and other related dimensions.

Methods

A cross-sectional, population-based online survey was conducted from April 4 to 15, 2020, in China. A total of 3,552 participants were included in this study. A descriptive measure of demographic information was used in this study. Multiple regression models and moderating effect analysis were used to estimate the effect of potential associations of risk perceptions.

Results

Those who showed negative emotions (depressed, helplessness, loneliness) and perceived video information in social media to be useful were positively correlated with risk perception, whereas individuals who perceived experts' advice to be useful, shared risk information with friends and thought that their community made adequate emergency preparation reported lower risk perception. The moderating effect of information perceived value (β = 0.020, p < 0.001) on the relationship between negative emotion and perception of risk was significant.

Conclusions

Individual differences in risk cognition during the COVID-19 pandemic were observed in subgroups of age level. Furthermore, the role of negative emotional states, the perceived usefulness of risk information and the sense of security also contributed to improving the public's risk perception. It is crucial for authorities to focus on residents' negative emotions and to clarify misinformation in accessible and effective ways in a timely manner.

The sex-dependent response to psychosocial stress and ischaemic heart disease

Stress is an important risk factor for modern chronic diseases, with distinct influences in males and females. The sex specificity of the mammalian stress response contributes to the sex-dependent development and impacts of coronary artery disease (CAD). Compared to men, women appear to have greater susceptibility to chronic forms of psychosocial stress, extending beyond an increased incidence of mood disorders to include a 2- to 4-fold higher risk of stress-dependent myocardial infarction in women, and up to 10-fold higher risk of Takotsubo syndrome-a stress-dependent coronary-myocardial disorder most prevalent in post-menopausal women. Sex differences arise at all levels of the stress response: from initial perception of stress to behavioural, cognitive, and affective responses and longer-term disease outcomes. These fundamental differences involve interactions between chromosomal and gonadal determinants, (mal)adaptive epigenetic modulation across the lifespan (particularly in early life), and the extrinsic influences of socio-cultural, economic, and environmental factors. Pre-clinical investigations of biological mechanisms support distinct early life programming and a heightened corticolimbic-noradrenaline-neuroinflammatory reactivity in females vs. males, among implicated determinants of the chronic stress response. Unravelling the intrinsic molecular, cellular and systems biological basis of these differences, and their interactions with external lifestyle/socio-cultural determinants, can guide preventative and therapeutic strategies to better target coronary heart disease in a tailored sex-specific manner.

A Systematic Review of Heart Rate Variability as a Measure of Stress in Medical Professionals

Understanding the physiological effects of responding to crises is a critical component in understanding how to manage and prepare medical professionals to be crisis responders. Heart rate variability (HRV) is the variation in rate between a succession of R-R intervals. This variation is not only affected by physiological processes such as respiration or metabolic rate but is also directly controlled by the autonomic nervous system. As such, heart rate variability has been proposed as a noninvasive tool to measure the physiological stress response. The aim of this systematic review is to consolidate heart rate variability literature in the context of medical emergencies to determine if heart rate variability changes predictably from baseline when responding to medical crises. This may demonstrate utility as an objective, noninvasive measure of stress response. A systematic literature review of six databases yielded 413 articles, 17 of which met our inclusion criteria of being written in English, measuring HRV in healthcare providers, and measuring HRV in real or simulated medical resuscitations or procedures. Articles were then analyzed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. Out of the 17 articles reviewed, 11 demonstrated statistically significant results showing heart rate variability responding in a predictable manner to stress. Three articles utilized a medical simulation as the stressor, six used medical procedures, and eight used medical emergencies encountered during clinical work. Overall, a predictable trend in heart rate variability metrics of standard deviation from the mean value of normal-to-normal (N-N) intervals (SDNN), root mean square of the successive differences (RMSSD), mean number of times per time interval in which the change in successive normal sinus (N-N) intervals exceeds 50 ms (PNN50), low frequency % (LF%), and low-frequency-to-high-frequency ratio (LF/HF) was observed when responding to stress. This systematic literature review showed that heart rate variability among healthcare providers responding to stressful scenarios follows a predictable pattern of change and expands our understanding of the physiology of stress in healthcare providers. This review supports the use of HRV to monitor stress during high-fidelity simulation to ensure that appropriate physiological arousal is achieved during the training of medical personnel.

Cardiovascular stress reactivity, habituation, and adiposity

The relationship between adiposity and cardiovascular disease morbidity and mortality is complex. One pathway through which adiposity may influence future health outcomes is by altering how biological systems respond to stress. The current study aimed to examine the association between two metrics of adiposity (body mass index and waist-hip ratio) and two indices of cardiovascular stress responses (reactivity and habituation). A sample of 455 participants (Mean age = 19.47, SD = 1.25 years; BMI = 24.32, SD = 5.04 kg/m² ; 62% female; 17.9% Hispanic/Latino; 65.2% White, 18.7% Asian, 7.9% Black, 0.2% American Indian/Alaska Native, and 7% other) completed two acute psychosocial stress tasks. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded throughout each stressor. In unadjusted and adjusted models, there were no statistically significant associations between adiposity and HR, SBP, or DBP stress reactivity or habituation. The current data do not support the hypothesis that adiposity influences health by altering cardiovascular responses to acute psychological stress. Results are at odds with prior population-level studies and the single prior study examining adiposity and habituation. At the same time, results are in line with mounting evidence that adiposity itself does not drive poor cardiovascular outcomes seen in people classified as overweight or obese.

A Framework for Interfacing and Partnering with Environmental Justice Communities as a Prelude to Human Health and Hazard Identification in the Vulnerable Census Tracts of Columbus, Ohio

Columbus, Ohio is one of the more prosperous, well-educated, and progressive cities in the United States. However, it ranks as the second worst life expectancy at birth, has a census tract wealth gap (27-year disparity), and one of the higher infant mortality rates in the country. These data suggest that there are likely several high-risk, vulnerable neighborhoods in Columbus with residents experiencing disparate and adverse outcomes. Illustrative of this fact are studies that have examined the social processes and mechanisms through which neighborhood contexts are at the forefront, including exposures to chemical stressors such as particulate matter (PM_2.5) as well as non-chemical stressors including violence, social determinants of health, zoning, and land use policies. It is documented that disparate and adverse outcomes are magnified in the vulnerable neighborhoods on the Near East Side as compared to Columbus city proper, Franklin County and/or the state of Ohio. As such, we developed a nuanced community engagement framework to identify potential environmental hazards associated with adverse pregnancy outcomes in those census tracts. The refined framework uses a blended version of traditional community-based participatory research (CBPR) models and is referred to as E⁶, Enhancing Environmental Endeavors via e-Equity, Education, and Empowerment.

Stress-level glucocorticoids increase fasting hunger and decrease cerebral blood flow in regions regulating eating

CONTEXT

The neural regulation of appetite and energy homeostasis significantly overlaps with the neurobiology of stress. Frequent exposure to repeated acute stressors may cause increased allostatic load and subsequent dysregulation of the cortico-limbic striatal system leading to inefficient integration of postprandial homeostatic and hedonic signals. It is therefore important to understand the neural mechanisms by which stress generates alterations in appetite that may drive weight gain.

OBJECTIVE

To determine glucocorticoid effects on metabolic, neural and behavioral factors that may underlie the association between glucocorticoids, appetite and obesity risk.

METHODS

A randomized double-blind cross-over design of overnight infusion of hydrocortisone or saline followed by a fasting morning perfusion magnetic resonance imaging to assess regional cerebral blood flow (CBF) was completed. Visual Analog Scale (VAS) hunger, cortisol and metabolic hormones were also measured.

RESULTS

Hydrocortisone relative to saline significantly decreased whole brain voxel based CBF responses in the hypothalamus and related cortico-striatal-limbic regions. Hydrocortisone significantly increased hunger VAS pre-scan, insulin, glucose and leptin, but not other metabolic hormones versus saline CBF groups. Hydrocortisone related increases in hunger were predicted by less reduction of CBF (hydrocortisone minus saline) in the medial OFC, medial brainstem and thalamus, left primary sensory cortex and right superior and medial temporal gyrus. Hunger ratings were also positively associated with plasma insulin on hydrocortisone but not saline day.

CONCLUSIONS

Increased glucocorticoids at levels akin to those experienced during psychological stress, result in increased fasting hunger and decreased regional cerebral blood flow in a distinct brain network of prefrontal, emotional, reward, motivation, sensory and homeostatic regions that underlie control of food intake.

Frontiers and Hotspots Evolution in Psycho-cardiology: A Bibliometric Analysis From 2004 to 2022

In the last 20 years, research on the topic of psycho-cardiology has gradually entered the public eye, with more innovations and applications of evidence-based medical research, biological mechanism research, and guideline consensus in the field of psycho-cardiology. This study uses a bibliometric approach to visualize and analyze the literature within the field of psycho-cardiology over the last 20 years to visualize the development process, research hotspots, and cutting-edge trends in clinical practice, mechanisms, and management strategies related to psycho-cardiology. Quantitative description and evaluation of 409 articles published in the field from 2004-2022 were conducted using CiteSpace and VOSviewer, to provide a theoretical reference for the development of psycho-cardiology.

Minor perturbations of thyroid homeostasis and major cardiovascular endpoints—Physiological mechanisms and clinical evidence

It is well established that thyroid dysfunction is linked to an increased risk of cardiovascular morbidity and mortality. The pleiotropic action of thyroid hormones strongly impacts the cardiovascular system and affects both the generation of the normal heart rhythm and arrhythmia. A meta-analysis of published evidence suggests a positive association of FT4 concentration with major adverse cardiovascular end points (MACE), but this association only partially extends to TSH. The risk for cardiovascular death is increased in both subclinical hypothyroidism and subclinical thyrotoxicosis. Several published studies found associations of TSH and FT4 concentrations, respectively, with major cardiovascular endpoints. Both reduced and elevated TSH concentrations predict the cardiovascular risk, and this association extends to TSH gradients within the reference range. Likewise, increased FT4 concentrations, but high-normal FT4 within its reference range as well, herald a poor outcome. These observations translate to a monotonic and sensitive effect of FT4 and a U-shaped relationship between TSH and cardiovascular risk. Up to now, the pathophysiological mechanism of this complex pattern of association is poorly understood. Integrating the available evidence suggests a dual etiology of elevated FT4 concentration, comprising both ensuing primary hypothyroidism and a raised set point of thyroid function, e. g. in the context of psychiatric disease, chronic stress and type 2 allostatic load. Addressing the association between thyroid homeostasis and cardiovascular diseases from a systems perspective could pave the way to new directions of research and a more personalized approach to the treatment of patients with cardiovascular risk.

Obesity and Type 2 Diabetes Mellitus Explained by the Free Energy Principle

According to the free energy principle, all sentient beings strive to minimize surprise or, in other words, an information-theoretical quantity called variational free energy. Consequently, psychosocial “stress” can be redefined as a state of “heightened expected free energy,” that is, a state of “expected surprise” or “uncertainty.” Individuals experiencing stress primarily attempt to reduce uncertainty, or expected free energy, with the help of what is called an uncertainty resolution program (URP). The URP consists of three subroutines: First, an arousal state is induced that increases cerebral information transmission and processing to reduce uncertainty as quickly as possible. Second, these additional computations cost the brain additional energy, which it demands from the body. Third, the program controls which stress reduction measures are learned for future use and which are not. We refer to an episode as “good” stress, when the URP has successfully reduced uncertainty. Failure of the URP to adequately reduce uncertainty results in either stress habituation or prolonged toxic stress. Stress habituation reduces uncertainty by flattening/broadening individual goal beliefs so that outcomes previously considered as untenable become acceptable. Habituated individuals experience so-called “tolerable” stress. Referring to the Selfish Brain theory and the experimental evidence supporting it, we show that habituated people, who lack stress arousals and therefore have decreased average brain energy consumption, tend to develop an obese type 2 diabetes mellitus phenotype. People, for whom habituation is not the free-energy-optimal solution, do not reduce their uncertainty by changing their goal preferences, and are left with nothing but “toxic” stress. Toxic stress leads to recurrent or persistent arousal states and thus increased average brain energy consumption, which in turn promotes the development of a lean type 2 diabetes mellitus phenotype. In conclusion, we anchor the psychosomatic concept of stress in the information-theoretical concept of uncertainty as defined by the free energy principle. In addition, we detail the neurobiological mechanisms underlying uncertainty reduction and illustrate how uncertainty can lead to psychosomatic illness.

How Stress Can Change Our Deepest Preferences: Stress Habituation Explained Using the Free Energy Principle

People who habituate to stress show a repetition-induced response attenuation—neuroendocrine, cardiovascular, neuroenergetic, and emotional—when exposed to a threatening environment. But the exact dynamics underlying stress habituation remain obscure. The free energy principle offers a unifying account of self-organising systems such as the human brain. In this paper, we elaborate on how stress habituation can be explained and modelled using the free energy principle. We introduce habituation priors that encode the agent’s tendency for stress habituation and incorporate them in the agent’s decision-making process. Using differently shaped goal priors—that encode the agent’s goal preferences—we illustrate, in two examples, the optimising (and thus habituating) behaviour of agents. We show that habituation minimises free energy by reducing the precision (inverse variance) of goal preferences. Reducing the precision of goal priors means that the agent accepts adverse (previously unconscionable) states (e.g., lower social status and poverty). Acceptance or tolerance of adverse outcomes may explain why habituation causes people to exhibit an attenuation of the stress response. Given that stress habituation occurs in brain regions where goal priors are encoded, i.e., in the ventromedial prefrontal cortex and that these priors are encoded as sufficient statistics of probability distributions, our approach seems plausible from an anatomical-functional and neuro-statistical point of view. The ensuing formal and generalisable account—based on the free energy principle—further motivate our novel treatment of stress habituation. Our analysis suggests that stress habituation has far-reaching consequences, protecting against the harmful effects of toxic stress, but on the other hand making the acceptability of precarious living conditions and the development of the obese type 2 diabetes mellitus phenotype more likely.

Mental Stress and Its Effects on Vascular Health

Coronary artery disease continues to be a major cause of morbidity and mortality despite significant advances in risk stratification and management. This has prompted the search for alternative nonconventional risk factors that may provide novel therapeutic targets. Psychosocial stress, or mental stress, has emerged as an important risk factor implicated in a higher incidence of cardiovascular events, and although our understanding of this far ranging and interesting phenomenon has developed greatly over recent times, there is still much to be learned regarding how to measure mental stress and how it may impact physical health. With the current coronavirus disease 2019 global pandemic and its incumbent lockdowns and social distancing, understanding the potentially harmful biological effects of stress related to life-changing events and social isolation has become even more important. In the current review our multidisciplinary team discusses stress from a psychosocial perspective and aims to define psychological stress as rigorously as possible; discuss the pathophysiologic mechanisms by which stress may mediate cardiovascular disease, with a particular focus to its effects on vascular health; outline existing methods and approaches to quantify stress by means of a vascular biomarker; outline the mechanisms whereby psychosocial stressors may have their pathologic effects ultimately transduced to the vasculature through the neuroendocrine immunologic axis; highlight areas for improvement to refine existing approaches in clinical research when studying the consequences of psychological stress on cardiovascular health; and discuss evidence-based therapies directed at reducing the deleterious effects of mental stress including those that target endothelial dysfunction. To this end we searched PubMed and Google Scholar to identify studies evaluating the relationship between mental or psychosocial stress and cardiovascular disease with a particular focus on vascular health. Search terms included "myocardial ischemia," "coronary artery disease," "mental stress," "psychological stress," "mental∗ stress∗," "psychologic∗ stress∗," and "cardiovascular disease∗." The search was limited to studies published in English in peer-reviewed journals between 1990 and the present day. To identify potential studies not captured by our database search strategy, we also searched studies listed in the bibliography of relevant publications and reviews.

2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines

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Relationship Between COVID-19 Related Knowledge and Anxiety Among University Students: Exploring the Moderating Roles of School Climate and Coping Strategies

The emergence of the COVID-19 pandemic resulted in abrupt disruptions in teaching and learning activities in higher education, with students from diverse programs suffering varying levels of anxieties. The physical education field happens to be one of the most affected academic areas due to its experiential content as a medium of instruction. In this study, we investigated the roles of school climate and coping strategies in the relationship between COVID-19 related knowledge and anxiety. Through the census approach, a cross-sectional sample of 760 students was administered a questionnaire in two universities offering Physical Education in Ghana: the University of Education, Winneba, and University of Cape Coast. The outcome of the study found a positive and significant link between COVID-19 knowledge and anxiety. Further, school climate and coping strategies significantly moderated the relationship between students' COVID-19 knowledge and associated anxiety. The findings have implications for creating a conducive school environment that reduces the risk of COVID-19 infection and through students' adoption of active coping strategies in an attempt to reduce psychological distress associated with COVID-19 anxiety.

Psychological stress, body shape and cardiovascular events: Results from the Whitehall II study

Background and aim

It is known that persistent psychological stress predicts changes in body shape in two different ways: some stressed people lose weight, others gain weight. It is also known that persistent psychological stress predicts adverse health events. But it is unknown what role the body shape plays in this particular network of relationships. We therefore analyzed the Whitehall II dataset to relate body shape to stress and health risk.

Methods

Data of 4969 men and 2138 women from the Whitehall II cohort were analyzed. Psychological stress (General Health Questionnaire) was measured three times in the years 1991 till 2001. Body shape (BMI, waist and hip circumferences) was measured in the years 1991 till 1994. Childhood adversities were retrospectively assessed by questionnaire. Outcomes included the incidence of non-fatal or fatal CHD events (coronary heart disease) collected up to the years 2012 and 2013 and all-cause mortality collected up to July 2015. Cox proportional hazard models were conducted to estimate the relation between psychological stress and CHD events or all-cause mortality.

Results

There was an increase in the expected hazard to develop CHD with high psychological stress (men: Exp (B) = 1.25 (1.06–1.47); P = 0.008; women: Exp (B) = 1.34 (1.05–1.70); P = 0.017). We found a clear dose-response relationship for the association between psychological stress and CHD events in both genders. That is, subjects with consistently high psychological stress in all assessments had a 2.4-fold (men) or 2.3-fold (women) higher risk for later CHD events compared to never-stressed subjects. Moreover, subjects with a high sum score of all 13 childhood experiences had a 10% increased hazard to develop fatal or non-fatal CHD events in adulthood. Although we could not find stress or BMI linked to all-cause mortality, the waist-to-hip ratio contributed to the risk of all-cause mortality in both genders (Exp (B) = 34.66 (6.43–186.92); P < 0.001 for men; Exp (B) = 60.65 (9.33–394.22); P < 0.001 for women).

Conclusion

This analysis supports the notion that psychological stress and childhood adversities are associated with the risk of fatal or non-fatal CHD events. When this relationship is analyzed in more detail, the Whitehall II dataset provides further insights into the role of body shape. That is, stress is also related to changes in body shape, with waist size in particular predicting higher all-cause mortality.

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We used Whitehall II data and constructed an overall picture of the relations between psychological stress, body shape and adverse health outcomes.

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We demonstrated a dose-dependent relationship between psychological stress and the risk of fatal or non-fatal CHD events.

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Stress increases the risk of both CHD events and body shape changes, with waist circumference but not BMI increasing the mortality risk.

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Body shape –more specifically waist size– is symptomatic of stress and predictive of all-cause mortality.

Chronic Stress A Potential Suspect Zero of Atherosclerosis: A Systematic Review

Atherosclerosis (AS) is a chronic vascular inflammatory disease, in which the lipid accumulation in the intima of the arteries shows yellow atheromatous appearance, which is the pathological basis of many diseases, such as coronary artery disease, peripheral artery disease and cerebrovascular disease. In recent years, it has become the main cause of death in the global aging society, which seriously endangers human health. As a result, research on AS is increasing. Lesions of atherosclerosis contain macrophages, T cells and other cells of the immune response, together with cholesterol that infiltrates from the blood. Recent studies have shown that chronic stress plays an important role in the occurrence and development of AS. From the etiology of disease, social, environmental and genetic factors jointly determine the occurrence of disease. Atherosclerotic cardio-cerebrovascular disease (ASCVD) is often caused by chronic stress (CS). If it cannot be effectively prevented, there will be biological changes in the body environment successively, and then the morphological changes of the corresponding organs. If the patient has a genetic predisposition and a combination of environmental factors triggers the pathogenesis, then chronic stress can eventually lead to AS. Therefore, this paper discusses the influence of chronic stress on AS in the aspects of inflammation, lipid metabolism, endothelial dysfunction, hemodynamics and blood pressure, plaque stability, autophagy, ferroptosis, and cholesterol efflux.

Longitudinal trends in the prevalence and treatment of depression among adults with cardiovascular disease: An analysis of national health and nutrition examination survey 2009-2020

OBJECTIVES

To assess the contemporary prevalence and decadal trends of depression and antidepressant use among adults with cardiovascular disease (CVD) in the United States, as well as their risk factors from 2009 to 2020.

MATERIALS AND METHODS

We used the National Health and Nutrition Examination Survey data to calculate the weighted prevalence of depression and antidepressant use. Adults aged 20 years or older with CVD were included. Depression and CVD were assessed by the Patient Health Questionnaire (PHQ-9) and self-report, respectively.

RESULTS

A total of 3,073 eligible participants with CVD aged >20 years were included. The overall prevalence of depression defined by PHQ-9 score ≥10 was 15.7% (95% CI 13.8-17.5), with a steady trend during 2009-March 2020 (p = 0.777). Female gender (aOR 1.78, 95% CI 1.20-2.64) and sleep disorder (aOR 2.62, 95% CI 1.78-3.86) were independent risk factors for depression in CVD patients, while high education level, high income, longer sleep duration, and non-current smokers were considered protective factors. The weighted prevalence of antidepressant use among depressed patients with CVD was 38.6%, which also remained unchanged during the survey period (p = 0.699). Participants with normal sleep pattern and duration were significantly less likely to take antidepressants (p = 0.003).

CONCLUSION

The longitudinal trends in the prevalence of depression among CVD patients in the United States have been stable over the past decade, despite being significantly higher in women, and those with sleep disorders. Overall, antidepressant use was fairly low. Aggressive screening and tailored treatment are recommended for specific vulnerable subpopulations to improve their clinical outcomes.

Coping Strategies Influence Cardiometabolic Risk Factors in Chronic Psychological Stress: A Post Hoc Analysis of A Randomized Pilot Study

Chronic psychological stress can result in physiological and mental health risks via the activation of the hypothalamic–pituitary–adrenal (HPA) axis, sympathoadrenal activity and emotion-focused coping strategies. The impact of different stress loads on cardiometabolic risk is poorly understood. This post hoc analysis of a randomized pilot study was conducted on 61 participants (18–65 years of age) with perceived chronic stress. The Perceived Stress Questionnaire (PSQ₃₀), Psychological Neurological Questionnaire (PNF), anthropometric, clinical and blood parameters were assessed. Subjects were assigned to ‘high stress’ (HS; PSQ₃₀ score: 0.573 ± 0.057) and ‘very high stress’ (VHS; PSQ₃₀ score: 0.771 ± 0.069) groups based on the PSQ₃₀. Morning salivary cortisol and CRP were elevated in both groups. Visceral adiposity, elevated blood pressure and metabolic syndrome were significantly more frequent in the HS group vs. the VHS group. The fatty liver index (FLI) was higher (p = 0.045), while the PNF score was lower (p < 0.001) in the HS group. The HS group was comprised of more smokers (p = 0.016). Energy intake and physical activity levels were similar in both groups. Thus, high chronic stress was related to visceral adiposity, FLI, elevated blood pressure and metabolic syndrome in the HS group, while very high chronic stress was associated with psychological–neurological symptoms and a lower cardiometabolic risk in the VHS group, probably due to different coping strategies.

Physical Activity, Stress, Depression, Emotional Intelligence, Logical Thinking, and Overall Health in a Large Lithuanian from October 2019 to June 2020: Age and Gender Differences Adult Sample

This study aimed to examine relationships and group differences among adult people’s (aged 18–74) physical activity (PA), expression of stress, depression, emotional intelligence (EI), logical thinking (LT), and overall health assessment. Two hypotheses were formulated before the study. The first hypothesis is that overweight and obesity in young adults (18 to 34 years) females and males, in particular, should increase sharply and this should be associated with decreased PA, abruptly deteriorating subject health, increased stress, depression, and poorer emotion management and EI. Second hypothesis: We further thought that the better people’s reflective thinking, the more they should live a healthier life (e.g., exercise more and eat healthier), their overweight and obesity should be small or none. We aimed to confirm or reject these two hypotheses. We applied a quantitative cross-sectional study design. The study results revealed that during the lifespan of 18–24 and 25–34 years (young adults) there was a sharp increase in overweight and obesity, a decrease in PA (and especially vigorous physical activity (VPA)) (and this was particularly evident in the male), while research participants felt less stress and depression, subjective assessment of health did not change, and EI increased steadily with age (18–24 to 65–74 years). The higher the EI of the research participants from 18–24 to 65–74 years of age the higher their moderate-to-vigorous physical activity (MVPA), the less stress and depression they felt. Based on the results, it can be said that both females and males prefer PA “with a hot heart rather than a cold mind.” We base this conclusion on the fact that females and males who have the highest EI also have the highest MVPA while LT is not associated with MVPA.

Brain Mass (Energy) Resistant to Hyperglycaemic Oversupply: A Systematic Review

Cerebral energy supply is determined by the energy content of the blood. Accordingly, the brain is undersupplied during hypoglycaemia. Whether or not there is an additional cerebral energy demand that depends upon the energy content of the brain is considered differently in two opposing theoretical approaches. The Selfish-Brain theory postulates that the brain actively demands energy from the body when needed, while long-held theories, the gluco-lipostatic theory and its variants, deny such active brain involvement and view the brain as purely passively supplied. Here we put the competing theories to the test. We conducted a systematic review of a condition in which the rival theories make opposite predictions, i.e., experimental T1DM. The Selfish-Brain theory predicts that induction of experimental type 1 diabetes causes minor mass (energy) changes in the brain as opposed to major glucose changes in the blood. This prediction becomes our hypothesis to be tested here. A total of 608 works were screened by title and abstract, and 64 were analysed in full text. According to strict selection criteria defined in our PROSPERO preannouncement and complying with PRISMA guidelines, 18 studies met all inclusion criteria. Thirteen studies provided sufficient data to test our hypothesis. The 13 evaluable studies (15 experiments) showed that the diabetic groups had blood glucose concentrations that differed from controls by +294 ± 96% (mean ± standard deviation) and brain mass (energy) that differed from controls by −4 ± 13%, such that blood changes were an order of magnitude greater than brain changes (T = 11.5, df = 14, p < 0.001). This finding confirms not only our hypothesis but also the prediction of the Selfish-Brain theory, while the predictions of the gluco-lipostatic theory and its variants were violated. The current paper completes a three-part series of systematic reviews, the two previous papers deal with a distal and a proximal bottleneck in the cerebral brain supply, i.e., caloric restriction and cerebral artery occlusion. All three papers demonstrate that accurate predictions are only possible if one regards the brain as an organ that regulates its energy concentrations independently and occupies a primary position in a hierarchically organised energy metabolism.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=156816, PROSPERO, identifier: CRD42020156816.

Increased depression risk in patients with abdominal aortic aneurysm: a nationwide cohort study

Purpose

Abdominal aortic aneurysm (AAA) is a critical disease. Most studies of AAA consider reoperation rate, complications, or mortality, but do not consider a patient's mental state. However, there is a possibility of interaction between AAA and depression in disease development and prognosis. We investigated the incidence and risk ratio of depression in patients with AAA using nationwide data.

Methods

We selected subjects from National Health Insurance System database who were diagnosed with AAA between 2009 and 2015 and survived at least 1 year after diagnosis or AAA surgery (n = 10,373). We determined the control group using propensity score matching by age and sex. The control group had about 3 times the number of subjects as the AAA cohort (n = 31,119).

Results

The incidence of depression was 1.4 times higher in the AAA group than the control group. We further analyzed the incidence of depression in the AAA group according to treatment modalities (nonsurgical vs. surgical or nonsurgical vs. open surgical aneurysm repair vs. endovascular aneurysm repair) but found no significant difference among them. The incidence of depression was significantly higher in patients aged <65 years than in patients aged ≥65 years (hazard ratio, 1.539 vs. 1.270; P < 0.001).

Conclusion

The incidence of depression was higher in the AAA group, with an especially high risk for depression in patients aged <65 years. The psychiatric status of patients with AAA should be carefully monitored for clinicians to intervene when appropriate.

Associations between increased circulating endothelial progenitor cell levels and anxiety/depressive severity, cognitive deficit and function disability among patients with major depressive disorder

The association of major depressive disorder (MDD) with cardiovascular diseases (CVDs) through endothelial dysfunction is bidirectional. Circulating endothelial progenitor cells (cEPCs), essential for endothelial repair and function, are associated with risks of various CVDs. Here, the relationship of cEPC counts with MDD and the related clinical presentations were investigated in 50 patients with MDD and 46 healthy controls. In patients with MDD, a battery of clinical domains was analysed: depressed mood with Hamilton Depression Rating Scale (HAMD) and Montgomery–Åsberg Depression Rating Scale (MADRS), anxiety with Hamilton Anxiety Rating Scale (HAMA), cognitive dysfunction and deficit with Digit Symbol Substitution Test (DSST) and Perceived Deficits Questionnaire-Depression (PDQ-D), somatic symptoms with Depressive and Somatic Symptom Scale (DSSS), quality of life with 12-Item Short Form Health Survey (SF-12) and functional disability with Sheehan Disability Scale (SDS). Immature and mature cEPC counts were measured through flow cytometry. Increased mature and immature cEPC counts were significantly associated with higher anxiety after controlling the confounding effect of systolic blood pressure, and potentially associated with more severe depressive symptoms, worse cognitive performance and increased cognitive deficit, higher social disability, and worse mental health outcomes. Thus, cEPCs might have pleiotropic effects on MDD-associated symptoms and psychosocial outcomes.

Dynamic Stress Responses and Real-Time Symptoms in Binge-Eating Disorder

BACKGROUND

Stress is a dynamic construct that predicts a range of health behaviors and conditions, including binge eating and excess weight. Thus far, there have been limited and inconsistent findings regarding stress responses in binge-eating disorder (BED) and insufficient consideration of temporal patterns of stress responses across the weight spectrum.

PURPOSE

The present study used ecological momentary assessment (EMA) to examine stress reactivity (i.e., the magnitude of the initial stress response), recovery (i.e., how long the stress response lasts before returning to baseline), and pileup (i.e., accumulation of repeated experiences of stressors and responses over time) as predictors of binge-eating symptoms (BES) and food craving in BED.

METHODS

Adults with BED (N = 115) completed a 7 day EMA protocol assessing stressful events, perceived stress, binge eating, and food craving prior to being randomized to a behavioral intervention.

RESULTS

Generalized estimating equations indicated that moments of greater stress pileup predicted greater subsequent BES (within-person effect). Participants with higher perceived stress and pileup reported greater overall BES and craving, and those with better recovery reported higher overall craving (between-person effects).

CONCLUSIONS

Findings highlight the importance of considering the dynamic nature of stress responses and, particularly, that the accumulation of stress over the day is an important trigger for BES.

Intergenerational upward mobility and racial differences in mortality among young adults: Evidence from county-level analyses

Inspired by the influential "deaths of despair" narrative, which emphasizes the role of worsening economic opportunity in driving the increasing mortality for non-Hispanic Whites in the recent decades, a rising number of studies have provided suggestive evidence that upward mobility levels across counties may partly explain variations in mortality rates. A gap in the literature is the lack of life-course studies examining the relationship between early-life upward mobility and later-life mortality across counties. Another gap is the lack of studies on how the relationship between upward mobility and mortality across counties varies across diverse sociodemographic populations. This study examines differences across race and sex in the relationship between early-life intergenerational upward mobility and early adulthood mortality at the county level. We use administrative data on upward mobility and vital statistics data on mortality across 3030 counties for those born between 1978 and 1983. We control for a variety of county-level socioeconomic variables in a model with fixed effects for state and year. Subgroup analyses by educational attainment and urban status were also performed for each race-sex combination. Results show strong negative relationships between early-life upward mobility and early adulthood mortality across racial-sex combinations, with a particularly greater magnitude for non-Hispanic Black males. In addition, individuals without a college degree and living in urban counties are particularly affected by early life upward mobility. The findings of this study highlight the vulnerability of less-educated, young urban Black males, due to the intersecting effects of the urban context, education, race, and sex.

Proximal Disruption of Brain Energy Supply Raises Systemic Blood Glucose: A Systematic Review

This work joins a series that methodically tests the predictions of the Selfish-Brain theory. The theory postulates a vital ability of the mammalian brain, namely to give priority to its own energy metabolism. The brain behaves “selfishly” in this respect. For the cerebral artery occlusion studied here, the theory predicts an increase in blood glucose concentration, what becomes the hypothesis to be tested. We conducted a systematic review of cerebral-artery-occlusion papers to test whether or not the included studies could confirm this hypothesis. We identified 239 records, screened 231 works by title or abstract, and analyzed 89 by full text. According to strict selection criteria (set out in our PROSPERO preregistration, complying with PRISMA guidelines), 7 papers provided enough information to decide on the hypothesis. Our hypothesis could be fully confirmed for the 3 to 24 h after the onset of a transient 2 h or permanent occlusion. As for the mechanism, the theory predicts that the energy-deprived brain suppresses insulin secretion via the sympathoadrenal system, thereby preventing insulin-mediated glucose uptake into muscle and fat and, as a result, enhancing insulin-independent glucose uptake via the blood-brain barrier. Evidence from our included studies actually demonstrated cerebral insulin suppression. In all, the current work confirms the second major prediction of the Selfish-Brain theory that relates to a proximal bottleneck of the cerebral supply chain, cerebral artery occlusion. Its first major prediction relates to a distal supply bottleneck, caloric restriction, and is fulfilled as shown by our previous work, whereas the prediction of the long held gluco-lipostatic theory, which sees the brain as only passively supplied, is violated (Sprengell et al., 2021). The crucial point was that caloric restriction elicits smaller changes in mass (energy) in the brain than in the body. Taken together, the evidence from the current and previous work clearly shows that the most accurate predictions are possible with a theory that views the brain as an independently self-regulating energy compartment occupying a primary position in energy metabolism.

Feelings of safety during daytime walking: associations with mental health, physical activity and cardiometabolic health in high vacancy, low-income neighborhoods in Detroit, Michigan

INTRODUCTION

Individuals living in low-income neighborhoods have disproportionately high rates of obesity, Type-2 diabetes, and cardiometabolic conditions. Perceived safety in one's neighborhood may influence stress and physical activity, with cascading effects on cardiometabolic health.

METHODS

In this study, we examined relationships among feelings of safety while walking during the day and mental health [perceived stress (PSS), depression score], moderate-to-vigorous physical activity (PA), Body Mass Index (BMI), and hemoglobin A1C (A1C) in low-income, high-vacancy neighborhoods in Detroit, Michigan. We recruited 69 adults who wore accelerometers for one week and completed a survey on demographics, mental health, and neighborhood perceptions. Anthropometrics were collected and A1C was measured using A1CNow test strips. We compiled spatial data on vacant buildings and lots across the city. We fitted conventional and multilevel regression models to predict each outcome, using perceived safety during daytime walking as the independent variable of interest and individual or both individual and neighborhood-level covariates (e.g., number of vacant lots). Last, we examined trends in neighborhood features according to perceived safety.

RESULTS

In this predominantly African American sample (91%), 47% felt unsafe during daytime walking. Feelings of perceived safety significantly predicted PSS (β = - 2.34, p = 0.017), depression scores (β = - 4.22, p = 0.006), and BMI (β = - 2.87, p = 0.01), after full adjustment. For PA, we detected a significant association for sex only. For A1C we detected significant associations with blighted lots near the home. Those feeling unsafe lived in neighborhoods with higher park area and number of blighted lots.

CONCLUSION

Future research is needed to assess a critical pathway through which neighborhood features, including vacant or poor-quality green spaces, may affect obesity-via stress reduction and concomitant effects on cardiometabolic health.

Glucocorticoids, metabolism and brain activity

The review integrates different experimental approaches including biochemistry, c-Fos expression, microdialysis (glutamate, GABA, noradrenaline and serotonin), electrophysiology and fMRI to better understand the effect of elevated level of glucocorticoids on the brain activity and metabolism. The available data indicate that glucocorticoids alter the dynamics of neuronal activity leading to context-specific changes including both excitation and inhibition and these effects are expected to support the task-related responses. Glucocorticoids also lead to diversification of available sources of energy due to elevated levels of glucose, lactate, pyruvate, mannose and hydroxybutyrate (ketone bodies), which can be used to fuel brain, and facilitate storage and utilization of brain carbohydrate reserves formed by glycogen. However, the mismatch between carbohydrate supply and utilization that is most likely to occur in situations not requiring energy-consuming activities lead to metabolic stress due to elevated brain levels of glucose. Excessive doses of glucocorticoids also impair the production of energy (ATP) and mitochondrial oxidation. Therefore, glucocorticoids have both adaptive and maladaptive effects consistently with the concept of allostatic load and overload.

The Relationship Between the Duration of Attention to Pandemic News and Depression During the Outbreak of Coronavirus Disease 2019: The Roles of Risk Perception and Future Time Perspective

Since the outbreak of coronavirus disease 2019 (COVID-19) in China, people have been exposed to a flood of media news related to the pandemic every day. Studies have shown that media news about public crisis events have a significant impact on individuals' depression. However, how and when the duration of attention to pandemic news predicts depression still remains an open question. This study established a moderated mediating model to investigate the relationship between the duration of attention to pandemic news and depression, the mediating effect of risk perception, and the moderating effect of future time perspective on the relationship. In early February 2020, 701 individuals from 29 provinces, autonomous regions, and municipalities across China were asked to self-report their duration of attention to pandemic news, level of depression, risk perception, and future time perspective during the COVID-19 outbreak. Results show that there is a significant positive correlation between the duration of attention to news on COVID-19 and depression; risk perception mediates the association between the duration of attention to pandemic news and depression; and future time perspective plays a moderating role between risk perception and depression. The findings of the present study provide theoretical implications and practically throw some light on alleviating the public's depression during pandemic periods. We highlight that the individual's hope for a better future, focusing on positive news, and time perspective balance during an epidemic disease are also beneficial to promoting positive emotion and reducing depression.

Epidemic Risk Perception, Perceived Stress, and Mental Health During COVID-19 Pandemic: A Moderated Mediating Model

The aim of the present study was to investigate relationships among epidemic risk perception, perceived stress, mental health (depression and anxiety), future time perspective, and confidence in society during the novel coronavirus disease (COVID-19) pandemic in China. Especially, we wonder that whether perceived stress mediates associations between epidemic risk perception and mental health and that whether future time perspective and confidence in society moderate the link between perceived stress and mental health. This cross-sectional study was conducted among 693 Chinese adults aged 18-60 years. The results showed that epidemic risk perception was positively related to perceived stress, depression, and anxiety. The correlations between epidemic risk perception and depression and anxiety were reduced when perceived stress was included, suggesting that perceived stress mediated these relationships. Moreover, the boundary conditions for the associations among perceived stress, depression, and anxiety were found in the study. Specifically, positive future time perspective could buffer the negative effects of perceived stress on depression, and confidence in society could weaken the negative effects of perceived stress on anxiety. Based on these findings, practical guidance and theoretical implications are provided for the public to maintain mental health during COVID-19 pandemic. Limitations and future directions are also discussed.

Brain More Resistant to Energy Restriction Than Body: A Systematic Review

The gluco-lipostatic theory and its modern variants assume that blood glucose and energy stores are controlled in closed-loop feedback processes. The Selfish Brain theory is based on the same assumptions, but additionally postulates that the brain, as an independent energy compartment, self-regulates its energy concentration with the highest priority. In some clinical situations these two theories make opposite predictions. To investigate one of these situations, namely caloric restriction, we formulated a hypothesis which, if confirmed, would match the predictions of the Selfish Brain theory—but not those of the gluco-lipostatic theory. Hypothesis: Calorie restriction causes minor mass (energy) changes in the brain as opposed to major changes in the body. We conducted a systematic review of caloric-restriction studies to test whether or not the evaluated studies confirmed this hypothesis. We identified 3,157 records, screened 2,804 works by title or abstract, and analyzed 232 by full text. According to strict selection criteria (set out in our PROSPERO preregistration, complying with PRISMA guidelines, and the pre-defined hypothesis-decision algorithm), 8 papers provided enough information to decide on the hypothesis: In animals, high-energy phosphates were measured by ³¹P-nuclear magnetic resonance, and organ and total body weights were measured by scales, while in humans organ sizes were determined by magnetic resonance imaging. All 8 decidable papers confirmed the hypothesis, none spoke against it. The evidence presented here clearly shows that the most accurate predictions are possible with a theory that regards the brain as independently self-regulating and as occupying a primary position in a hierarchically organized energy metabolism.

Valuing what happens: a biogenic approach to valence and (potentially) affect

Valence is half of the pair of properties that constitute core affect, the foundation of emotion. But what is valence, and where is it found in the natural world? Currently, this question cannot be answered. The idea that emotion is the body's way of driving the organism to secure its survival, thriving and reproduction runs like a leitmotif from the pathfinding work of Antonio Damasio through four book-length neuroscientific accounts of emotion recently published by the field's leading practitioners. Yet while Damasio concluded 20 years ago that the homeostasis-affect linkage is rooted in unicellular life, no agreement exists about whether even non-human animals with brains experience emotions. Simple neural animals-those less brainy than bees, fruit flies and other charismatic invertebrates-are not even on the radar of contemporary affective research, to say nothing of aneural organisms. This near-sightedness has effectively denied the most productive method available for getting a grip on highly complex biological processes to a scientific domain whose importance for understanding biological decision-making cannot be underestimated. Valence arguably is the fulcrum around which the dance of life revolves. Without the ability to discriminate advantage from harm, life very quickly comes to an end. In this paper, we review the concept of valence, where it came from, the work it does in current leading theories of emotion, and some of the odd features revealed via experiment. We present a biologically grounded framework for investigating valence in any organism and sketch a preliminary pathway to a computational model. This article is part of the theme issue 'Basal cognition: conceptual tools and the view from the single cell'.

Cooperation and Social Rules Emerging From the Principle of Surprise Minimization

The surprise minimization principle has been applied to explain various cognitive processes in humans. Originally describing perceptual and active inference, the framework has been applied to different types of decision making including long-term policies, utility maximization and exploration. This analysis extends the application of surprise minimization (also known as free energy principle) to a multi-agent setup and shows how it can explain the emergence of social rules and cooperation. We further show that in social decision-making and political policy design, surprise minimization is superior in many aspects to the classical approach of maximizing utility. Surprise minimization shows directly what value freedom of choice can have for social agents and why, depending on the context, they enter into cooperation, agree on social rules, or do nothing of the kind.

Effects of Life Events and Social Isolation on Stroke and Coronary Heart Disease

The current coronavirus disease 2019 (COVID-19) pandemic represents a severe, life-changing event for people across the world. Life changes may involve job loss, income reduction due to furlough, death of a beloved one, or social stress due to life habit changes. Many people suffer from social isolation due to lockdown or physical distancing, especially those living alone and without family. This article reviews the association of life events and social isolation with cardiovascular disease, assembling the current state of knowledge for stroke and coronary heart disease. Possible mechanisms underlying the links between life events, social isolation, and cardiovascular disease are outlined. Furthermore, groups with increased vulnerability for cardiovascular disease following life events and social isolation are identified, and clinical implications of results are presented.

Chronic stress and arthritis: a scoping review

OBJECTIVE

Emerging research supports the role of chronic stress in chronic disease development. This scoping review aimed to map the field of research exploring relationships between chronic stress and the development of arthritis in adult populations.

METHODS

Five electronic databases were systematically searched without publication limits based on three key concepts: stress, arthritis and adults. Eligible qualitative studies investigated individuals' perceived causes of arthritis; quantitative studies investigated relationships between exposure to a chronic stressor and an arthritis presence outcome. Articles were screened by two independent reviewers and data were narratively synthesised.

RESULTS

Of 1819 unique records, 54 studies met inclusion criteria. Nine studies used qualitative methods and 45 used quantitative methods. Studies increased chronologically, with half (n = 27) published since 2010. Chronic stress exposures were heterogenous; most were categorised as adverse life events (n = 22) or adverse childhood experiences (n = 17). Self-reported arthritis was the most frequent measure of arthritis outcome (n = 26) in quantitative studies. A majority of studies (n = 41) suggested a relationship between exposure to chronic stressors and arthritis development.

CONCLUSION

Increasing study numbers in the past decade may reflect increasing awareness of the potential impact of chronic stress in arthritis development, consistent with a biopsychosocial approach to chronic disease aetiology and management. Further research, using precise arthritis definitions, conducted within a clearly articulated pathophysiological framework, is required to establish a causal relationship between exposure to chronic stressors and the development of specific arthritis conditions.

Chronic physical health conditions and associated factors among people with serious orthopaedic injuries: A systematic review

Introduction

A clear understanding of the development of chronic physical health conditions following orthopaedic injury is essential to fully recognise the magnitude and burden of injury, improve treatment and predict certain outcomes. This review aimed at systematically identifying and evaluating current evidence of the incidence and prevalence of chronic physical health conditions and factors associated with chronic physical health conditions following serious orthopaedic injury.

Materials and method

Systematic literature search was performed using Ovid MEDLINE, Scopus, and Embase via Ovid, Cochrane Library and Ovid Emcare up to 30 December 2018. Observational studies relating to the incidence or prevalence of chronic physical health conditions and associated factors in people with serious orthopaedic injuries were included. Data extraction and methodological quality assessment were carried out independently by 2 reviewers.

Result

Of the 4835 references identified in the initial search, only five studies with sample sizes ranging from 83 to 3846 met the criteria for inclusion. The most prevalent conditions reported in people with serious orthopaedic injury included coronary artery disease, arrhythmias, myocardial infarction, hypertension, diabetes mellitus and chronic heart failure. Bronchial, rectal, prostate and breast cancers were also causes of late death in orthopaedic injury survivors. Most of the studies included in this review were unable to determine whether these conditions were related to injuries.

Conclusions

Chronic physical health conditions are prevalent among people with serious orthopaedic injury. Little is known about factors associated with chronic physical health conditions following serious orthopaedic injury or whether physical health conditions are associated with injury. Further work needs to be done to identify causal pathways and the longer-term effects of orthopaedic injury on the risk of developing chronic physical health conditions.

Relationships between Chronic Diseases and Depression among Middle-aged and Elderly People in China: A Prospective Study from CHARLS

Given the rapid increase in the prevalence of chronic diseases in aging populations, this prospective study including 17 707 adults aged ≥45 years from China Health and Retirement Longitudinal Study was used to estimate the associations between chronic disease, multimorbidity, and depression among middle-aged and elderly adults in China, and explore the mediating factors. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) questionnaire. Twelve chronic physical conditions, including hypertension, diabetes, dyslipidemia, cancer, chronic lung disease, liver disease, heart failure, stroke, kidney disease, arthritis or rheumatism, asthma, digestive disease were assessed. The prevalence rates for physical multimorbidity and depression (CES-D-10 ≥10) were 43.23% and 36.62%, respectively. Through multivariable logistic models and generalized estimating equation (GEE) models, we found all 12 chronic physical conditions, and multimorbidity were significantly associated with depression. Both mobility problems and chronic pain explained more than 30% of the association for all chronic conditions, with particularly high percentages for stroke (51.56%) and cancer (51.06%) in mobility problems and cancer (53.35%) in chronic pain. Limited activities of daily living (ADL) explained 34.60% of the stroke-cancer relationship, while sleep problems explained between 10.15% (stroke) and 14.89% (chronic lung disease) of the association. Individuals with chronic diseases or multimorbidity are significantly more likely to be depressed. Functional symptoms involving limitations of ADL and mobility difficulties mediated much of the association between chronic diseases and incident depression. These symptoms could be targeted for interventions to ameliorate the incidence of depression among individuals with chronic conditions.

Meet Your Stress Management Professionals: The Endocannabinoids

The endocannabinoid signaling system (ECSS) is altered by exposure to stress and mediates and modulates the effects of stress on the brain. Considerable preclinical data support critical roles for the endocannabinoids and their target, the CB1 cannabinoid receptor, in the adaptation of the brain to repeated stress exposure. Chronic stress exposure increases vulnerability to mental illness, so the ECSS has attracted attention as a potential therapeutic target for the prevention and treatment of stress-related psychopathology. We discuss human genetic studies indicating that the ECSS contributes to risk for mental illness in those exposed to severe stress and trauma early in life, and we explore the potential difficulties in pharmacological manipulation of the ECSS.

Reflections on Bruce S. McEwen's contributions to stress neurobiology and so much more

The authors highlight, from a firsthand perspective, Bruce S. McEwen's seminal influence on the field of stress neurobiology and beyond, and how these investigations have yielded important insights, principles and critical questions that continue to guide stress research today. Featured are discussion of: 1) the important inverted-U relationship between stress/glucocorticoids and optimal physiological function, 2) stress adaptation and the role of adaptive stress responses, 3) mechanisms by which the short-term stress response promotes heightened immune function and immunity, and 4) the far reaching impact of the theoretical framework of allostasis and allostatic load-concepts that have created new bridges between stress physiology, biomedical sciences, health psychology and sociology.

Stress, Resilience, and Cardiovascular Disease Risk Among Black Women

BACKGROUND

Empirical data on the link between stress and cardiovascular disease (CVD) risk among black women is limited. We examined associations of stressful life events and social strain with incident CVD among black women and tested for effect modification by resilience.

METHODS AND RESULTS

Our analysis included 10 785 black women enrolled in the Women's Health Initiative Observational Study and Clinical Trials cohort. Participants were followed for CVD for up to 23 years (mean, 12.5). Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for associations between stress-related exposures and incident CVD. We included interactions between follow-up time (age) and stressful life events because of evidence of nonproportional hazards. Effect modification by resilience was examined in the sub-cohort of 2765 women with resilience and stressful life events measures. Higher stressful life events were associated with incident CVD at ages 55 (hazard ratio for highest versus lowest quartile=1.80; 95% CI, 1.27-2.54) and 65 (hazard ratio for highest versus lowest quartile=1.40; 95% CI, 1.16-1.68), but not at older ages. Adjustment for CVD risk factors attenuated these associations. Similar associations were observed for social strain. In the sub-cohort of women with updated stressful life events and resilience measures, higher stressful life events were associated with incident CVD in multivariable-adjusted models (hazard ratio=1.61; 95% CI, 1.04-2.51). Resilience did not modify this association nor was resilience independently associated with incident CVD.

CONCLUSIONS

In this cohort of older black women, recent reports of stressful life events were related to incident CVD. Resilience was unrelated to incident CVD.

CLINICAL TRIALS REGISTRATION

URL: https://www.clinicaltrials.gov . Unique identifier: NCT00000611.

Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants

PURPOSE

Depressive symptoms relapse and remit over time, perhaps differentially by race and income. Few studies have examined whether time-varying depressive symptoms (TVDS) differentially predict mortality. We sought to determine whether race (white/black) and income (</≥$35,000) moderate the association between TVDS and mortality in a large cohort.

METHODS

The REGARDS study is a prospective cohort study among community-dwelling U.S. adults aged 45 years or older. Cox proportional hazard models were constructed to separately analyze the association between mortality (all cause, cardiovascular death, noncardiovascular death, and cancer death) and TVDS in race and income stratified models.

RESULTS

Point estimates were similar and statistically significant for white (aHR = 1.24 [95% CI: 1.10, 1.41]), black (aHR = 1.26 [95% CI: 1.11, 1.42]), and low-income participants (aHR = 1.28 [95% CI: 1.16, 1.43]) for the association between TVDS and mortality. High-income participants had a lower hazard (aHR = 1.19 [95% CI: 1.02, 1.38]). Baseline depressive symptoms predicted mortality in blacks only (aHR = 1.17, 95% CI: [1.00, 1.35]).

CONCLUSIONS

We found that TVDS significantly increased the immediate hazard of mortality similarly across race and income strata. TVDS may provide more robust evaluations of depression impact compared with the baseline measures, making apparent racial disparities cited in the extant literature a reflection of the imperfection of using baseline measures.