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Longpré-Poirier C, Miron JP, Garel N, Samson-Daoust E, Rizkallah E, Desbeaumes Jodoin V, Juster RP, Lespérance P. Elevated allostatic load is associated with poorer response to repetitive transcranial magnetic stimulation in treatment-resistant depression. Psychiatry Res 2024; 340:116122. [PMID: 39137557 DOI: 10.1016/j.psychres.2024.116122] [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: 02/17/2024] [Revised: 07/25/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024]
Abstract
This cohort study investigated whether allostatic load (AL) is associated with treatment response to repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD). Pre-treatment blood samples measured AL across multiple systems. Pre- and post-treatment mood changes were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). Associations between AL and treatment outcomes were explored. Higher pre-treatment AL was significantly associated with poorer post-treatment response status but was not significantly associated with smaller reduction in MADRS score after 4 weeks of treatment. Identifying biomarker profiles informed by the AL model could enhance treatment decisions in TRD, reducing risks associated with prolonged, ineffective rTMS trials and emphasizing the need for reliable predictive biomarkers.
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Affiliation(s)
- Christophe Longpré-Poirier
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada; Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada; Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada; Centre de recherche de l'Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada.
| | - Jean-Philippe Miron
- Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada; Interventional Psychiatry Program (IPP), UC San Diego School of Medicine, San Diego, CA, USA
| | - Nicolas Garel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Eugénie Samson-Daoust
- Centre de recherche de l'Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada
| | - Elie Rizkallah
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
| | - Véronique Desbeaumes Jodoin
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada; Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada; Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
| | - Robert-Paul Juster
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada; Centre de recherche de l'Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada
| | - Paul Lespérance
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada; Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada; Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
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LeMasters K, D'Alessio AS, Touma F, Andrabi N, Brinkley-Rubinstein L, Gutierrez C. The physiological toll of arrests: An examination of arrest history on midlife allostatic load. Ann Epidemiol 2024; 96:1-12. [PMID: 38796042 PMCID: PMC11283360 DOI: 10.1016/j.annepidem.2024.05.007] [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: 02/23/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE To understand how allostatic load - cumulative physiologic burden of stress - varies by amount and timing of arrests stratified by race/ethnicity and by sex. METHODS Using The National Longitudinal Study of Adolescent to Adult Health, we calculated descriptive statistics and mean differences in bio-marker measured allostatic load by arrest history stratified by race/ethnicity and sex. RESULTS One-third of participants experienced at least one arrest, and most experienced arrests only as adults. Allostatic load scores were higher for those that had ever experienced an arrest compared to never (mean difference: 0.58 (0.33, 0.84)). Similar results held for men and women and across race/ethnicity, but Black non-Hispanic individuals had higher allostatic load at all levels compared to other individuals. CONCLUSIONS Experiencing both any arrest and multiple arrests were associated with higher allostatic load. The stress of arrests may contribute to physiological maladaptations and poor health. The public health and law enforcement fields must recognize the detrimental consequences of arrests on physiological stress and search for non-carceral solutions.
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Affiliation(s)
- Katherine LeMasters
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado Medical Campus, Aurora, CO, USA; Department of Epidemiology, School of Public Health, University of Colorado Medical Campus, Aurora, CO, USA.
| | - Alena Sorensen D'Alessio
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fatima Touma
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nafeesa Andrabi
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Carmen Gutierrez
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Watts CA, Smith J, Giacomino R, Walter D, Jang G, Malik A, Harvey N, Novak CM. Chemogenetic Excitation of Ventromedial Hypothalamic Steroidogenic Factor 1 (SF1) Neurons Increases Muscle Thermogenesis in Mice. Biomolecules 2024; 14:821. [PMID: 39062535 PMCID: PMC11274921 DOI: 10.3390/biom14070821] [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: 05/04/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Allostatic adaptations to a perceived threat are crucial for survival and may tap into mechanisms serving the homeostatic control of energy balance. We previously established that exposure to predator odor (PO) in rats significantly increases skeletal muscle thermogenesis and energy expenditure (EE). Evidence highlights steroidogenic factor 1 (SF1) cells within the central and dorsomedial ventromedial hypothalamus (c/dmVMH) as a modulator of both energy homeostasis and defensive behavior. However, the brain mechanism driving elevated EE and muscle thermogenesis during PO exposure has yet to be elucidated. To assess the ability of SF1 neurons of the c/dmVMH to induce muscle thermogenesis, we used the combined technology of chemogenetics, transgenic mice, temperature transponders, and indirect calorimetry. Here, we evaluate EE and muscle thermogenesis in SF1-Cre mice exposed to PO (ferret odor) compared to transgenic and viral controls. We detected significant increases in muscle temperature, EE, and oxygen consumption following the chemogenetic stimulation of SF1 cells. However, there were no detectable changes in muscle temperature in response to PO in either the presence or absence of chemogenetic stimulation. While the specific role of the VMH SF1 cells in PO-induced thermogenesis remains uncertain, these data establish a supporting role for SF1 neurons in the induction of muscle thermogenesis and EE similar to what is seen after predator threats.
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Affiliation(s)
- Christina A. Watts
- School of Biomedical Sciences, Kent State University, Kent, OH 44242, USA;
| | - Jordan Smith
- College of Public Health, Kent State University, Kent, OH 44242, USA
| | - Roman Giacomino
- Department of Biological Sciences, Kent State University, Kent, OH 44242, USA
| | - Dinah Walter
- Department of Biological Sciences, Kent State University, Kent, OH 44242, USA
| | - Guensu Jang
- Department of Biological Sciences, Kent State University, Kent, OH 44242, USA
| | - Aalia Malik
- Department of Biological Sciences, Kent State University, Kent, OH 44242, USA
| | - Nicholas Harvey
- Department of Biological Sciences, Kent State University, Kent, OH 44242, USA
| | - Colleen M. Novak
- School of Biomedical Sciences, Kent State University, Kent, OH 44242, USA;
- Department of Biological Sciences, Kent State University, Kent, OH 44242, USA
- Brain Health Research Institute, Kent State University, Kent, OH 44242, USA
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Petrova D, Ubago-Guisado E, Garcia-Retamero R, Redondo-Sánchez D, Pérez-Gómez B, Catena A, Caparros-Gonzalez RA, Sánchez MJ. Allostatic Load and Depression Symptoms in Cancer Survivors: A National Health and Nutrition Examination Survey Study. Cancer Nurs 2024; 47:290-298. [PMID: 36920171 DOI: 10.1097/ncc.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Individuals with cancer often experience stress throughout the cancer trajectory and have a high risk of experiencing depression. OBJECTIVE The aim of this study was to examine the relationship between allostatic load (AL), a measure of cumulative stress-related physiologic dysregulation of different body systems, and symptoms of depression in cancer survivors. METHODS Participants were 294 adult cancer survivors from the US National Health and Nutrition Examination Survey (NHANES 2007-2018). Allostatic load was measured using 14 indicators representing cardiometabolic risk, glucose metabolism, cardiopulmonary functioning, parasympathetic functioning, and inflammation. Depressive symptoms were measured with the Patient Health Questionnaire-9. The relationship between AL and depressive symptoms was investigated using multiple regression adjusted for diverse sociodemographic and diagnosis variables. RESULTS Higher AL was associated with higher depressive symptom scores. The higher risk of depression was concentrated among those survivors in the highest AL quartile, with 21% (95% confidence interval, 11%-32%) of survivors presenting a high risk of depression compared with 8% to 11% of survivors in the lower quartiles. In exploratory analyses, the relationship between AL and depressive symptoms was only significant among survivors with a lower income. In contrast, in survivors in the highest income group, depressive symptoms were lower and unrelated to AL. CONCLUSION High AL is associated with more depressive symptoms among cancer survivors. IMPLICATIONS FOR PRACTICE Nurses have an important role in identifying psychological distress in cancer patients and survivors. Further research is needed to investigate the usefulness of AL as a marker in the context of cancer follow-up care and screening for psychological distress.
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Affiliation(s)
- Dafina Petrova
- Author Affiliations: Instituto de Investigación Biosanitaria, ibs.GRANADA (Drs Petrova, Ubago-Guisado, Caparros-Gonzalez, and Sánchez, and Mr Rendondo-Sánchez), Granada; Escuela Andaluza de Salud Pública (Drs Petrova, Ubago-Guisado, and Sánchez, and Mr Rendondo-Sánchez), Granada; CIBER of Epidemiology and Public Health (Drs Petrova, Ubago-Guisado, Pérez-Gómez, and Sánchez, and Mr Rendondo-Sánchez), Madrid; University of Granada (Drs Garcia-Retamero, Catena, and Caparros-Gonzalez); National Center for Epidemiology, Health Institute Carlos III (Dr Pérez-Gómez), Madrid; and Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada (Dr Sánchez), Spain
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Gianfredi V, Stacchini L, Minutolo G, De Nicolò V, Berselli N, Ancona A, Catalini A, Cedrone F. Impacts of Unhealthy Behaviors on Mental Health among Public Health Residents: The PHRASI Study. Diseases 2024; 12:134. [PMID: 39057105 PMCID: PMC11275475 DOI: 10.3390/diseases12070134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/18/2024] [Accepted: 06/22/2024] [Indexed: 07/28/2024] Open
Abstract
Unhealthy behaviors (UBs) can affect mental health. The most impactful of these are alcohol abuse, sedentary behavior, and sleep disturbances. Since these UBs are not well explored in medical residents, this study aims to overcome this gap, focusing on outcomes such as depression and anxiety. The Public Health Residents' Anonymous Survey in Italy (PHRASI) is a nationwide cross-sectional study based on an 88-item questionnaire. UBs were explored through validated questionnaires: the Alcohol Use Disorders Identification Test-c (AUDIT-C), the International Physical Activity Questionnaire (IPAQ), and the Insomnia Severity Index (ISI). Depressive symptoms and anxiety were detected by Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Hierarchical cluster analysis described clusters using responses from the AUDIT-C, IPAQ, and ISI. A total of 375 participants were included in this study. Three distinct clusters (CL) were identified: CL1 was characterized by a moderate risk for alcohol abuse and high insomnia dissatisfaction, with a significantly higher frequency of depressive symptoms (46%, p < 0.001) and anxiety (53%, p < 0.001); CL2 had no risk for alcohol abuse, high sleep satisfaction, and better mental health profile, with the lowest prevalence of depressive symptoms (15%, p < 0.001); CL3 had the highest risk of alcohol abuse, the highest rate of physical activity (40%, p = 0.013), and the lowest prevalence of anxiety (27%, p < 0.001). Subjects belonging to CL1 required much more attention to prevent the worsening of mental outcomes. Interventions for promoting mental health should be addressed in all Public Health schools to create more sustainable working conditions.
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Affiliation(s)
- Vincenza Gianfredi
- Department of Biomedical Sciences for Health, University of Milan, via Pascal, 36, 20133 Milan, Italy;
| | - Lorenzo Stacchini
- Department of Health Science, University of Florence, 50121 Firenze, Italy
| | - Giuseppa Minutolo
- Food Hygiene, Nutritional Surveillance and Prevention, Department of Prevention, Provincial Healthcare Authority of Palermo, 90129 Palermo, Italy;
| | - Valentina De Nicolò
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy;
| | - Nausicaa Berselli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi, 287, 41125 Modena, Italy;
| | - Angela Ancona
- School of Public Health, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Alessandro Catalini
- UOC Igiene degli Alimenti e Nutrizione, Dipartimento di Prevenzione, AST Macerata, 62100 Macerata, Italy;
| | - Fabrizio Cedrone
- Hospital Management, Local Health Authority of Pescara, 65100 Pescara, Italy
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von Känel R. Stress-Induced Hypercoagulability: Insights from Epidemiological and Mechanistic Studies, and Clinical Integration. Semin Thromb Hemost 2024. [PMID: 38914118 DOI: 10.1055/s-0044-1787660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
By integrating findings from comprehensive reviews, meta-analyses, and cutting-edge genetic studies, this article illuminates the significance of stress-induced hypercoagulability in clinical medicine. In particular, the findings from numerous prospective cohort studies indicate that stress and hemostatic factors of a hypercoagulable state are associated with increased incident risk and poor prognosis for atherosclerotic cardiovascular disease and venous thromboembolism. Mendelian randomization studies suggest that these associations are partially causal. The review synthesizes extensive research on the link between acute and chronic stress and hypercoagulability, outlining a potential pathway from stress to thrombosis risk. Consistent with the allostatic load concept, acute stress-induced hypercoagulability, initially adaptive, can turn maladaptive under chronic stress or excessive acute stress, leading to arterial or venous thrombotic events. Individuals with predisposing factors, including atherosclerosis, thrombophilia, or immobilization, may exhibit an increased risk of thrombotic disease during stress. Contextual sociodemographic characteristics, the stress experience, and coping resources additionally modulate the extent of stress-induced hypercoagulability. Research into the neuroendocrine, cellular, and molecular bases reveals how stress influences platelet activation coagulation and fibrinolysis. The activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, along with vagal withdrawal, and the effects of catecholamines, cortisol, and vasopressin, are the central mechanisms involved. Hemoconcentration, inflammation, endothelial dysfunction, and thrombopoiesis additionally contribute to stress-induced hypercoagulability. Further research is needed to prove a causal link between chronic stress and hypercoagulability. This includes exploring its implications for the prevention and management of thrombotic diseases in stressed individuals, with a focus on developing effective psychosocial and pharmacological interventions.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Ogunyemi D, Thind BS, Teixeira A, Sams CM, Ojo M, Dinkins GAE, Serseni D. Integrating Cultural Humility into Medical Education Using a Structured and Interactive Workshop. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:575-583. [PMID: 38911069 PMCID: PMC11193470 DOI: 10.2147/amep.s460970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/01/2024] [Indexed: 06/25/2024]
Abstract
Background Cultural humility is a lifelong commitment to self-evaluation, redressing power imbalances in patient-physician relationships and developing mutually trusting beneficial partnerships. Objective The objective of this study was to determine the feasibility and efficacy of cultural humility training. Methods From July 2020-March 2021, 90-minute educational workshops attended by 133 medical students, resident physicians and medical education faculty included 1) pre- and post- intervention surveys; 2) interactive presentation on equity and cultural humility principles; 3) participants explored sociocultural identities and power; and 4) reflective group discussions. Results There were significant increases from pre to post intervention assessments for perception scores (3.89 [SEM= 0.04] versus 4.22 [0.08], p<0.001) and knowledge scores (0.52 [0.02] versus 0.67 [0.02], p<0.001). Commonest identities participants recognized as changing over time were personality = 40%, appearance = 36%, and age =35%. Commonest identities experienced as oppressed/subjugated were race/ethnicity = 54%, gender = 40% and religion = 28%; whilst commonest identities experienced as privileged were gender= 49%, race/ethnicity = 42% and appearance= 25%. Male participants assigned mean power score of 73% to gender identity compared to mean power score of -8% by female participants (P<0.001). Non-Hispanic Whites had mean power score for race identity of 62% compared to 13% for non-white participants (p<0.001). English as a second language was only acknowledged as an oppressed/subjugated identity by those born outside the United States (p<0.001). Conclusion An interactive educational workshop can increase participants' knowledge and perceptions regarding cultural humility. Participants can self-reflect to recognize sociocultural identities that are oppressed/subjugated or privileged.
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Affiliation(s)
- Dotun Ogunyemi
- DIO, Associate Dean of Graduate Medical Education; Charles R Drew University, College of Medicine, Los Angeles, CA, USA
| | - Birpartap S Thind
- Medical Student, California University of Science and Medicine, Colton, CA, USA
| | - Amir Teixeira
- Medical Student, California University of Science and Medicine, Colton, CA, USA
| | - Clarence M Sams
- Medical Student, Charles R Drew University, College of Medicine, Los Angeles, CA, USA
| | - Matthias Ojo
- Medical Student, Charles R Drew University, College of Medicine, Los Angeles, CA, USA
| | - Grace Anne E Dinkins
- DIO, Associate Dean of Graduate Medical Education; Charles R Drew University, College of Medicine, Los Angeles, CA, USA
| | - Dragos Serseni
- DIO, Associate Dean of Graduate Medical Education; Charles R Drew University, College of Medicine, Los Angeles, CA, USA
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Perrella L, Mucherino S, Casula M, Illario M, Orlando V, Menditto E. Polypharmacy Management in Chronic Conditions: A Systematic Literature Review of Italian Interventions. J Clin Med 2024; 13:3529. [PMID: 38930058 PMCID: PMC11204469 DOI: 10.3390/jcm13123529] [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: 05/10/2024] [Revised: 06/03/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Potentially inappropriate polypharmacy (PIP) is among the major factors leading to adverse drug reactions, increased healthcare costs, reduced medication adherence, and worsened patient conditions. This study aims to identify existing interventions implemented to monitor and manage polypharmacy in the Italian setting. Methods: A systematic literature review (PROSPERO: CRD42023457049) was carried out according to the PRISMA statement guidelines. PubMed, Embase, ProQuest, and Web of Science were queried without temporal constraints, encompassing all published papers until October 2023. Inclusion criteria followed the PICO model: patients with polypharmacy; interventions to monitor/manage polypharmacy regimen versus no/any intervention; outcomes in terms of intervention effectiveness and cost variation. Results: After duplicate deletion, 153 potentially relevant publications were extracted. Following abstract and full-text screenings, nine articles met the inclusion criteria. Overall, 78% (n = 7) were observational studies, 11% (n = 1) were experimental studies, and 11% (n = 1) were two-phase studies. A total of 44% (n = 4) of the studies involved patients aged ≥ 65 years, while 56% (n = 5) were disease-specific. Monitoring was the most prevalent choice of intervention (67%; n = 6). Outcomes were mainly related to levels of polypharmacy (29%; n = 6) and comorbidities (29%; n = 6), effectiveness rates (14%; n = 3), and avoidable costs (9%; n = 2). Conclusions: This review outlines that Italy is still lacking in interventions to monitor/manage PIP, addressing an unmet need in developing patient-tailored strategies for reducing health-system burden.
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Affiliation(s)
- Lara Perrella
- CIRFF-Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (L.P.); (S.M.); (V.O.)
| | - Sara Mucherino
- CIRFF-Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (L.P.); (S.M.); (V.O.)
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy;
- IRCCS MultiMedica Hospital, Sesto S. Giovanni, 20099 Milan, Italy
| | - Maddalena Illario
- Division of Health Innovation, Campania Region Health Directorate, 80143 Naples, Italy;
| | - Valentina Orlando
- CIRFF-Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (L.P.); (S.M.); (V.O.)
| | - Enrica Menditto
- CIRFF-Center of Pharmacoeconomics and Drug Utilization, Department of Pharmacy, University of Naples Federico II, 80131 Naples, Italy; (L.P.); (S.M.); (V.O.)
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Brown JM, Sofis M, Zimmer S, Kaplan BA. Delay discounting is associated with addiction and mental health measures while controlling for health behaviors and health barriers in a large US sample. Addict Behav Rep 2024; 19:100545. [PMID: 38680208 PMCID: PMC11046061 DOI: 10.1016/j.abrep.2024.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/20/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
Background Excessive discounting of future rewards [delay discounting (DD)] may be a transdiagnostic process and treatment target underlying behavioral health outcomes, including trauma, depression, anxiety, and problematic substance use. However, multiple health behaviors and barriers are also related to these outcomes, including social media usage, adverse childhood experiences (ACEs), sleep quality, healthcare access, housing status, and exercise. To extend research examining DD as transdiagnostic process, we recruited a large, heterogenous sample to examine the association between DD, problematic substance use, and mental health outcomes while controlling for certain health behaviors and health barriers. Method In a cross-sectional online survey of 3992 US residents, we administered validated measures of PTSD, depression, anxiety, and problematic alcohol, stimulant, and opioid use. Using linear or ordinal logistic models, scores for each outcome were regressed onto DD while controlling for demographics, health behaviors, and health barriers. Results Including only DD and demographics, DD was associated with each outcome at low effect sizes (ƒ2 = .013, OR range = 1.08-1.16). Except for opioid ASSIST scores, these relationships held when controlling for social media usage, sleep, housing status, healthcare access, ACEs, physical exercise, and demographic variables (ƒ2 = .002, OR range = 1.03-1.12), increasing confidence that DD concurrently and directly relates to four of these five clinical outcomes. Discussion These findings support the conceptualization of DD as a transdiagnostic process underlying certain psychopathologies and suggest targeting DD in co-occurring substance use disorder and/or mental health treatments may result in clinically significant outcomes.
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Affiliation(s)
- Jeremiah M. Brown
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
| | - Michael Sofis
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
| | - Sara Zimmer
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
| | - Brent A. Kaplan
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
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Honkalampi K, Kraav SL, Kerr P, Juster RP, Virtanen M, Hintsa T, Partonen T, Lehto SM. Associations of allostatic load with sociodemographic factors, depressive symptoms, lifestyle, and health characteristics in a large general population-based sample. J Affect Disord 2024; 350:784-791. [PMID: 38266933 DOI: 10.1016/j.jad.2024.01.189] [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: 05/31/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We examined the associations between allostatic load (AL) and sociodemographic factors, depressive symptoms, lifestyle and health characteristics in a population-based sample of 4993 adults in Finland. METHODS Thirteen biomarkers were used to construct AL. High AL was defined as scoring highly in ≥4 items. RESULTS AL scores of 4 and above were exceeded in the age group of 45-54 years in men and 65-74 years in women. Age was the strongest predictor for belonging to the high AL score group. In addition, elevated depressive symptoms (BDI-6 ≥ 4), male sex, not engaging in physical exercise, high alcohol use and a low level of education were associated with an increased likelihood of belonging to the high AL group. CONCLUSION The older the participants were, the greater their AL burden was. However, AL burden increased more steeply as a function of age in men. In addition to lifestyle interventions, effective prevention strategies for depression at the population level could have a major public health impact in reducing the accumulation of AL burden.
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Affiliation(s)
- Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
| | - Siiri-Liisi Kraav
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Philippe Kerr
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Robert-Paul Juster
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Taina Hintsa
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Timo Partonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Soili M Lehto
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; R&D Department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway; Department of Psychiatry, University of Helsinki, Helsinki, Finland
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Juster RP, Rutherford C, Keyes K, Hatzenbuehler ML. Associations Between Structural Stigma and Allostatic Load Among Sexual Minorities: Results From a Population-Based Study. Psychosom Med 2024; 86:157-168. [PMID: 38345315 DOI: 10.1097/psy.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Structural forms of stigma and discrimination are associated with adverse health outcomes across numerous stigmatized groups, including lesbian, gay, and bisexual (LGB) individuals. However, the biological consequences of structural stigma among LGB populations are understudied. To begin to address this gap, we assessed associations between indicators of structural stigma (i.e., state-level policies) targeting LGB individuals and allostatic load (AL) indices representing physiological dysregulations. METHODS Pooled data from the continuous 2001-2014 National Health and Nutritional Examination Survey were analyzed (LGB: n = 864; heterosexual: n = 20,310). Ten state-level LGB-related policies (e.g., employment nondiscrimination protections, same-sex marriage) were used to operationalize structural stigma. A sex-specific AL index representing 11 immune, metabolic, and cardiovascular biomarkers was estimated. Multilevel models were used to examine associations between structural stigma and AL, net of nine individual-level characteristics (e.g., education, race/ethnicity, age, and health behaviors). RESULTS Sexual minority men living in states with low levels of structural stigma experienced significantly lower AL ( β = -0.45, p = .02) compared with sexual minority men living in states with high structural stigma (i.e., fewer protective policies). There was no significant association between structural stigma and AL among sexual minority women. CONCLUSIONS By demonstrating direct associations between structural stigma and indices of physiological dysregulation, our findings provide a mechanistic understanding of how the social environment can "get under the skin and skull" for sexual minority men in the United States. Future research should explore whether these mechanisms generalize to other marginalized groups exposed to structural stigma.
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Affiliation(s)
- Robert-Paul Juster
- From the Department of Psychiatry and Addiction (Juster), University of Montreal; Research Center of the Montreal Mental Health University Institute (Juster), Montreal, Quebec, Canada; Department of Epidemiology, Mailman School of Public Health, Columbia University (Rutherford, Keyes), New York, New York; and Department of Psychology, Harvard University (Hatzenbuehler), Cambridge, Massachusetts
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Lai KY, Kumari S, Gallacher J, Webster CJ, Sarkar C. Association between Residential Greenness and Allostatic Load: A Cohort Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:4884-4893. [PMID: 38437596 DOI: 10.1021/acs.est.3c04792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
The association between residential greenness and allostatic load (AL), a marker of composite physiological burden and predictor of chronic disease, remains understudied. This study comprised 212,600 UK Biobank participants recruited over 2007 and 2010 at the baseline. Residential greenness was modeled as the normalized difference vegetation index (NDVI) from high spatial resolution (0.50 m) color infrared imagery and measured within a 0.5 km radial catchment. AL was measured as a composite index from 13 biomarkers comprising three physiological systems (metabolic, cardiovascular, and inflammatory systems) and two organ systems (liver and kidney). Multilevel mixed-effects generalized linear models with a random intercept for UK Biobank assessment centers were employed to examine the association between residential greenness and AL. Each interquartile range (IQR = 0.24) increment in NDVI greenness was associated with lower AL (beta (β) = -0.28, 95% confidence interval (CI) = -0.55, -0.01). Consistently, relative to the lowest NDVI greenness quintile, participants in the highest quintile had lower AL (β = -0.64, 95% CI = -1.02, -0.26). The proportion of the association between greenness and AL mediated by the physical activity was 3.2%. In conclusion, residential greenness was protectively associated with AL, a composite marker of wear and tear and general health.
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Affiliation(s)
- Ka Yan Lai
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
- Department of Urban Planning & Design, Faculty of Architecture, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Sarika Kumari
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Christopher John Webster
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
- Department of Urban Planning & Design, Faculty of Architecture, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
- Urban Systems Institute, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
- Department of Urban Planning & Design, Faculty of Architecture, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
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Halabicky OM, Giang CW, Miller AL, Peterson KE. Lead exposure, glucocorticoids, and physiological stress across the life course: A systematic review. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 345:123329. [PMID: 38281572 DOI: 10.1016/j.envpol.2024.123329] [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: 12/15/2022] [Revised: 12/13/2023] [Accepted: 01/06/2024] [Indexed: 01/30/2024]
Abstract
The biological pathways linking lead exposure to adverse outcomes are beginning to be understood. Rodent models suggest lead exposure induces dysfunction within the hypothalamic-pituitary-adrenal (HPA) axis and glucocorticoid regulation, a primary physiological stress response system. Over time, HPA axis and glucocorticoid dysfunction has been associated with adverse neurocognitive and cardiometabolic health, much like lead exposure. This systematic review utilized PRISMA guidelines to synthesize the literature regarding associations between lead exposure and downstream effector hormones of the HPA axis, including cortisol, a glucocorticoid, and dehydroepiandrosterone (DHEA), a glucocorticoid antagonist. We additionally determined the state of the evidence regarding lead exposure and allostatic load, a measure of cumulative body burden resultant of HPA axis and glucocorticoid dysfunction. A total of 18 articles were included in the review: 16 assessed cortisol or DHEA and 3 assessed allostatic load. Generally, the few available child studies suggest a significant association between early life lead exposure and altered cortisol, potentially suggesting the impact of developmental exposure. In adulthood, only cross sectional studies were available. These reported significant associations between lead and reduced cortisol awakening response and increased cortisol reactivity, but few associations with fasting serum cortisol. Two studies reported significant associations between increasing lead exposure and allostatic load in adults and another between early life lead exposure and adolescent allostatic load. The paucity of studies examining associations between lead exposure and allostatic load or DHEA and overall heterogeneity of allostatic load measurements limit conclusions. However, these findings cautiously suggest associations between lead and dysregulation of physiological stress pathways (i.e., glucocorticoids) as seen through cortisol measurement in children and adults. Future research would help to elucidate these associations and could further examine the physiological stress pathway as a mediator between lead exposure and detrimental health outcomes.
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Affiliation(s)
- O M Halabicky
- Department of Nutritional Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA.
| | - C W Giang
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA.
| | - A L Miller
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA.
| | - K E Peterson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, USA.
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Tonkikh O, Chi NC, Herr KA, Fishman SM, Young HM. Supporting the Health and Well-Being of Caregivers of Persons with Pain Strategies to address stress and improve self-care. Home Healthc Now 2024; 42:103-109. [PMID: 38437044 DOI: 10.1097/nhh.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Tonkikh, O., et al. Supporting the Health and Well-Being of Caregivers of Persons with Pain. Am J Nurs 2023; 123 (6): 55-61.
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Kerr P, Le Page C, Giguère CÉ, Marin MF, Trudel-Fitzgerald C, Romain AJ, Taschereau-Dumouchel V, Ouellet-Morin I, Lecomte T, Potvin S, Geoffrion S, Sasseville M, Caihol L, Lipp O, Pelletier JF, Dumais A, Lesage A, Labelle R, Lavoie M, Godbout R, Vincent P, Boissonneault J, Findlay H, Lupien SJ, Guay S, Juster RP, Consortium S. The Signature Biobank: A longitudinal biopsychosocial repository of psychiatric emergency patients. Psychiatry Res 2024; 332:115718. [PMID: 38198857 DOI: 10.1016/j.psychres.2024.115718] [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: 08/01/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
The Signature Biobank is a longitudinal repository of biospecimen, psychological, sociodemographic, and diagnostic data that was created in 2012. The Signature Consortium represents a group of approximately one hundred Quebec-based transdisciplinary clinicians and research scientists with various expertise in the field of psychiatry. The objective of the Signature Biobank is to investigate the multi-faceted underpinnings of psychiatric disorders among patients in crisis. The Signature Consortium is expanding and includes new active members that seek to highlight the contributions made by Signature Biobank since its inception. This article details our research protocol, directions, and summarizes contributions. To date, we have collected biological samples (n = 1,986), and questionnaire data (n = 2,085) from psychiatric emergency patients of the Institut universitaire en santé mentale de Montréal (Quebec, Canada), with a large proportion from whom both data types were collected (n = 1,926). In addition to this, a subsample of patients was followed-up at hospital discharge, and two additional outpatient clinic appointments (n = 958 with at least one follow-up). In addition, a socio-demographically matched comparison group of individuals who were not hospitalized for psychiatric disorders (n = 149) was recruited from the surrounding catchment area. To summarize, a systematic review of the literature shows that the Signature Biobank has contributed to better characterizing psychiatric comorbidities, biological profiles, and psychosocial functioning across some of the most common psychiatric disorders, including psychosis, mood, anxiety, and substance use disorders. The Signature Biobank is now one of the world's largest repositories of data collected from patients receiving care at a psychiatric emergency unit.
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Affiliation(s)
- Philippe Kerr
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Cécile Le Page
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Charles-Édouard Giguère
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Marie-France Marin
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Département de Psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Claudia Trudel-Fitzgerald
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Ahmed Jérôme Romain
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, Québec, Canada
| | - Vincent Taschereau-Dumouchel
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Ouellet-Morin
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; School of Criminology, Université de Montréal, Montréal, Québec, Canada
| | - Tania Lecomte
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Stéphane Potvin
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Steve Geoffrion
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
| | - Marc Sasseville
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Lionel Caihol
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Olivier Lipp
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Jean-François Pelletier
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry, Yale University, New Haven, Connecticut, United States; CISSS de la Montérégie-Ouest, Québec, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Alain Lesage
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Réal Labelle
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Département de Psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Marc Lavoie
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Roger Godbout
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Vincent
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | - Janick Boissonneault
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Helen Findlay
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Sonia J Lupien
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Stéphane Guay
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada; School of Criminology, Université de Montréal, Montréal, Québec, Canada
| | - Robert-Paul Juster
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada.
| | - Signature Consortium
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
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John-Henderson NA, Ginty AT. Profiles of historical loss and childhood trauma as predictors of mental and cardiometabolic health in American Indian adults. SSM - MENTAL HEALTH 2023; 4:100252. [PMID: 38188870 PMCID: PMC10769154 DOI: 10.1016/j.ssmmh.2023.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Cardiometabolic disease and mental health conditions are two major contributors to persistent inequities in health and life expectancy for American Indian adults. The atrocities associated with European colonization are linked to intergenerational psychological and emotional wounding (i.e., historical trauma) and high incidence of childhood trauma. Prior work has examined the independent relationships of childhood trauma and thoughts about historical loss with cardiometabolic and mental health in American Indians. In the current work, we used a data-driven approach to identify profiles of childhood trauma and frequency of thoughts about historical loss, and then examined how these profiles related to cardiometabolic and mental health in a sample of American Indian adults from across the United States (N = 727). We found that a profile characterized by high levels of childhood trauma and high frequency of thoughts about historical losses was associated with the greatest risk for mental health conditions. The profile characterized by the highest levels of childhood trauma and by moderate frequency of thoughts about historical losses was associated with the largest risk of cardiometabolic conditions. The findings represent an important first step towards understanding how childhood trauma and thoughts about historical loss may simultaneously inform enduring inequities in American Indian health.
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Affiliation(s)
| | - Annie T. Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
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Portillo C, Adinoff B, Spencer CT, Field CA. The association of allostasis with alcohol use: A case-control study in males with and without alcohol use disorder. Alcohol 2023; 112:9-16. [PMID: 37454744 DOI: 10.1016/j.alcohol.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Allostatic load (AL) is associated with a heightened predisposition to disease due to prolonged activation of biological stress-response systems. Alcohol use disorder (AUD) is known to activate these systems. The primary aim of the current study was to examine the relationship between AL and AUD. METHODS Participants were males (100%) with DSM-IV Alcohol Dependence (n = 48) and healthy participants with no history of substance use disorder (n = 17). Participants with AUD were 4-6 weeks abstinent. The AL index used cortisol, interleukin-6 (IL-6), fibrinogen, tumor necrosis factor-alpha (TNFα), C-reactive protein (CRP), glucose, insulin, leptin, pulse, systolic blood pressure readings, diastolic blood pressure readings, and body mass index (BMI). Physiological dysregulation for each biological measure was determined based on values within the 25th or 75th percentiles; AL was calculated as the total number of physiologically dysregulated biological measures. RESULTS No differences in mean AL scores between the cases and controls [t(63) = .48, p = .633] were observed. Among cases, AL was not associated with lifetime drinks per drinking day (F(2,42) = .42, p = .662), lifetime total drinks (F(2,42) = 0.48, p = .620), total drinks 6 months prior to participating in the study (F(2,43) = 0.58, p = .563), or drinks per drinking day at 3-month follow-up (F(2,35) = 1.93, p = .161). AL was negatively associated with drinks per drinking day 6 months prior to study participation (F(2,42) = 3.71, p = .033). CONCLUSIONS The hypotheses were not supported. Given that alcohol is likely to lead to physiological dysregulation, the apparent absence of a relationship between biomarkers of cumulative stress as indicated by AL and drinking status was both unanticipated and remarkable. Based on the results, AL in the context of drinking status or drinking among males with AUD may not be applicable.
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Affiliation(s)
- Carlos Portillo
- The Latino Alcohol and Health Disparities Research and Training Center at The University of Texas at El Paso, El Paso, TX, United States.
| | - Bryon Adinoff
- The University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Charles T Spencer
- The University of Texas at El Paso, Department of Biological Sciences, El Paso, TX, United States
| | - Craig A Field
- The Latino Alcohol and Health Disparities Research and Training Center at The University of Texas at El Paso, El Paso, TX, United States; The University of Texas at El Paso, Department of Psychology, El Paso, TX, United States
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Yu YL, Juster RP. Spousal Synchrony in Allostatic Load Among Older Couples in the Health and Retirement Study. Psychosom Med 2023; 85:716-726. [PMID: 37409786 DOI: 10.1097/psy.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Using national data from the Health and Retirement Study, this study examined interpartner associations of allostatic load (AL) among 2338 different-sex couples ( N = 4676 individuals) over a 4-year period among older American couples from a dyadic approach. METHODS AL was indexed by immune (C-reactive protein), metabolic (high-density lipoprotein cholesterol, total cholesterol, and glycosylated hemoglobin), renal (cystatin C), cardiovascular (systolic and diastolic blood pressures, pulse rate), and anthropometric (waist and body mass index) parameters using the traditional count-based formulation. Actor-partner interdependence models were used to assess interpartner concordance in AL. RESULTS Higher partners' baseline AL was significantly associated with higher own AL both at baseline and 4 years later. In addition, partners' baseline AL was significantly associated with own AL 4 years later only in women but not men. Lastly, we did not observe any significant moderating effect of relationship quality on interpartner AL concordance. CONCLUSIONS The findings suggest that older couples' physiological responses to environmental stress are not only linked concurrently, but the associations persist after 4 years, alluding to long-term impacts of couples' psychosocial context and physiology on each other.
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Affiliation(s)
- Yan-Liang Yu
- From the Department of Sociology and Criminology (Yu), Howard University, Washington, DC; Department of Psychiatry and Addiction (Juster), University of Montreal; and Center on Sex*Gender, Allostasis, and Resilience, Research Center of the Montreal (Juster), Mental Health University Institute, Montreal, Canada
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Igboanugo S, Mielke J. The allostatic load model: a framework to understand the cumulative multi-system impact of work-related psychosocial stress exposure among firefighters. Health Psychol Behav Med 2023; 11:2255026. [PMID: 37711429 PMCID: PMC10498803 DOI: 10.1080/21642850.2023.2255026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/28/2023] [Indexed: 09/16/2023] Open
Abstract
Firefighting is recognised as a profession where health and well-being can be affected by a variety of occupational factors, such as physical, thermal, and chemical stressors. Along with the risks intuitively associated with the fire service, however, psychosocial stress has begun to attract attention as another variable deserving of consideration. Indeed, long-term exposure to work-related psychosocial stress has been linked with poor health outcomes in many workers; however, despite this association, very little has been done to examine how such stressors become biologically embedded in firefighters. To help facilitate research into how psychosocial stress can affect health-related outcomes in the fire service, we propose a framework centered on the notion of allostatic load. First, we reviewed the occupational characteristics that may generate psychosocial stress within firefighters before introducing allostatic load (that is, dysregulation across various physiological systems caused by the need to manage ongoing stressors). Next, we provided a summary of how allostatic load can be measured and touched on the framework's utility for studying the cumulative effects of work-related stress on firefighter health. After this, factors that may influence the steps leading from stress exposure to health outcomes were discussed; in particular, we commented upon how research in this area should consider specific non-modifiable (age, sex, and ethnicity) and modifiable (psychosocial resources and behavioural habits) factors. Finally, we presented methodological barriers and opportunities that may arise when using the allostatic load framework with this professional group. By introducing the framework, we hope to provide a tool that may be used by those interested in stress-health research in firefighters to build the evidence needed to inform primary prevention measures.
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Affiliation(s)
- Somkene Igboanugo
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Patient Education and Engagement, University Health Network, Toronto, Canada
| | - John Mielke
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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Zainal NH, Newman MG. Prospective network analysis of proinflammatory proteins, lipid markers, and depression components in midlife community women. Psychol Med 2023; 53:5267-5278. [PMID: 35924730 PMCID: PMC9898473 DOI: 10.1017/s003329172200232x] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/07/2022] [Accepted: 07/04/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Vulnerability theories propose that suboptimal levels of lipid markers and proinflammatory proteins predict future heightened depression. Scar models posit the reverse association. However, most studies that tested relationships between non-specific immune/endocrine markers and depression did not separate temporal inferences between people and within-person and how different immunometabolism markers related to unique depression symptoms. We thus used cross-lagged prospective network analyses (CLPN) to investigate this topic. METHODS Community midlife women (n = 2224) completed the Center for Epidemiologic Studies-Depression scale and provided biomarker samples across five time-points spanning 9 years. CLPN identified significant relations (edges) among components (nodes) of depression (depressed mood, somatic symptoms, interpersonal issues), lipid markers [insulin, fasting glucose, triglycerides, low-density lipoprotein-cholesterol (LDL), high-density lipoprotein-cholesterol (HDL)], and proinflammatory proteins [C-reactive protein (CRP), fibrinogen], within and across time-points. All models adjusted for age, estradiol, follicle-stimulating hormone, and menopausal status. RESULTS In within-person temporal networks, higher CRP and HDL predicted all three depression components (d = 0.131-2.112). Increased LDL preceded higher depressed mood and interpersonal issues (v. somatic symptoms) (d = 0.251-0.327). Elevated triglycerides predicted more somatic symptoms (v. depressed mood and interpersonal problems) (d = 0.131). More interpersonal problems forecasted elevated fibrinogen and LDL levels (d = 0.129-0.331), and stronger somatic symptoms preceded higher fibrinogen levels (d = 0.188). CONCLUSIONS Results supported both vulnerability and scar models. Long-term dysregulated immunometabolism systems, social disengagement, and related patterns are possible mechanistic accounts. Cognitive-behavioral therapies that optimize nutrition and physical activity may effectively target depression.
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Affiliation(s)
- Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Michelle G. Newman
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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Giddens E, Noy B, Steward T, Verdejo-García A. The influence of stress on the neural underpinnings of disinhibited eating: a systematic review and future directions for research. Rev Endocr Metab Disord 2023; 24:713-734. [PMID: 37310550 PMCID: PMC10404573 DOI: 10.1007/s11154-023-09814-4] [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] [Accepted: 05/29/2023] [Indexed: 06/14/2023]
Abstract
Disinhibited eating involves overconsumption and loss of control over food intake, and underpins many health conditions, including obesity and binge-eating related disorders. Stress has been implicated in the development and maintenance of disinhibited eating behaviours, but the mechanisms underlying this relationship are unclear. In this systematic review, we examined how the impact of stress on the neurobiological substrates of food-related reward sensitivity, interoception and cognitive control explains its role in disinhibited eating behaviours. We synthesised the findings of functional magnetic resonance imaging studies including acute and/or chronic stress exposures in participants with disinhibited eating. A systematic search of existing literature conducted in alignment with the PRISMA guidelines identified seven studies investigating neural impacts of stress in people with disinhibited eating. Five studies used food-cue reactivity tasks, one study used a social evaluation task, and one used an instrumental learning task to probe reward, interoception and control circuitry. Acute stress was associated with deactivation of regions in the prefrontal cortex implicated in cognitive control and the hippocampus. However, there were mixed findings regarding differences in reward-related circuitry. In the study using a social task, acute stress associated with deactivation of prefrontal cognitive control regions in response to negative social evaluation. In contrast, chronic stress was associated with both deactivation of reward and prefrontal regions when viewing palatable food-cues. Given the small number of identified publications and notable heterogeneity in study designs, we propose several recommendations to strengthen future research in this emerging field.
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Affiliation(s)
- Emily Giddens
- Turner Institute for Brain and Mental Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton, VIC 3800 Australia
| | - Brittany Noy
- Turner Institute for Brain and Mental Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton, VIC 3800 Australia
| | - Trevor Steward
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC Australia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC Australia
| | - Antonio Verdejo-García
- Turner Institute for Brain and Mental Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton, VIC 3800 Australia
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Lewis NA, Hill PL. Sense of purpose in life and allostatic load in two longitudinal cohorts. J Psychosom Res 2023; 170:111346. [PMID: 37148605 DOI: 10.1016/j.jpsychores.2023.111346] [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: 03/07/2023] [Revised: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Sense of purpose in life has been linked with better physical health, longevity, and reduced risk for disability and dementia, but the mechanisms linking sense of purpose with diverse health outcomes are unclear. Sense of purpose may promote better physiological regulation in response to stressors and health challenges, leading to lower allostatic load and disease risk over time. The current study examined the association between sense of purpose in life and allostatic load over time in adults over age 50. METHODS Data from the nationally representative US Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA) were used to examine associations between sense of purpose and allostatic load across 8 and 12 years of follow-up, respectively. Blood-based and anthropometric biomarkers were collected at four-year intervals and used to compute allostatic load scores based on clinical cut-off values representing low, moderate, and high risk. RESULTS Population-weighted multilevel models revealed that sense of purpose in life was associated with lower overall levels of allostatic load in HRS, but not in ELSA after adjusting for relevant covariates. Sense of purpose in life did not predict rate of change in allostatic load in either sample. CONCLUSIONS The present investigation supports sense of purpose predicting preserved differentiation of allostatic regulation, with more purposeful individuals demonstrating consistently lower allostatic load over time. Persistent differences in allostatic burden may account for divergent health trajectories between individuals low and high in sense of purpose.
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Affiliation(s)
- Nathan A Lewis
- Department of Psychology, University of Victoria, Victoria, BC, Canada; Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada.
| | - Patrick L Hill
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
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Abrahamyan A, Soares S, Correia D, Oliveira A, Fraga S. Childhood social adversity and clustering of health risk behaviours during early adolescence in a population-based birth cohort. Public Health 2023; 220:80-87. [PMID: 37276777 DOI: 10.1016/j.puhe.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/29/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES This study aimed to prospectively explore the association between early lifetime exposure to psychosocial adversity and engagement in health risk behaviours (HRBs) during early adolescence. STUDY DESIGN This was a prospective study. METHODS This study used data from the baseline (2005-2006), third (2016-2017) and fourth waves (2018-2020) of the Generation XXI birth cohort. Socio-economic circumstances (SECs) at baseline, adverse childhood experiences (ACEs; e.g. abuse, neglect, household dysfunction) at age 10 years and HRBs (i.e. alcohol consumption, smoking, physical exercise level, sedentary behaviours, sleep duration and eating behaviours) at age 13 years were measured. Patterns of HRBs were obtained using latent class analysis. Latent class regression analysis was used to estimate the likelihood of being engaged in HRBs according to the extent of exposure to ACEs (i.e. 0 ACEs, 1-3 ACEs, 4-5 ACEs and ≥6 ACEs) and negative family SECs. RESULTS Adolescents whose mothers had a low level of education (adjusted odds ratio [aOR] = 2.72 [95% confidence interval {CI}, 2.33-3.18]), low occupational status (aOR = 3.21 [95% CI, 2.68-3.85]) and low income (aOR = 2.70 [95% CI, 2.23-3.28]) were more likely to be engaged in HRBs than their peers with higher SECs. Adolescents who experienced more ACEs were at a significantly increased risk of involvement in HRBs (aOR = 1.86 [95% CI, 1.33-2.63] for 4-5 ACEs vs aOR 2.41 [95% CI, 1.72-3.43] for ≥6 ACEs). No significant gender differences were observed. CONCLUSIONS Adolescents from families with low SECs were more likely than their more affluent counterparts to be engaged in HRBs. Furthermore, more ACEs contributed to widening health inequalities.
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Affiliation(s)
- A Abrahamyan
- EPIUnit - Instituto de Saúde Pública da Universidade Do Porto, Porto, Portugal; ITR- Laboratório para a Investigação Integrativa e Translacional, Porto, Portugal
| | - S Soares
- EPIUnit - Instituto de Saúde Pública da Universidade Do Porto, Porto, Portugal; ITR- Laboratório para a Investigação Integrativa e Translacional, Porto, Portugal
| | - D Correia
- EPIUnit - Instituto de Saúde Pública da Universidade Do Porto, Porto, Portugal; ITR- Laboratório para a Investigação Integrativa e Translacional, Porto, Portugal
| | - A Oliveira
- EPIUnit - Instituto de Saúde Pública da Universidade Do Porto, Porto, Portugal; ITR- Laboratório para a Investigação Integrativa e Translacional, Porto, Portugal
| | - S Fraga
- EPIUnit - Instituto de Saúde Pública da Universidade Do Porto, Porto, Portugal; ITR- Laboratório para a Investigação Integrativa e Translacional, Porto, Portugal.
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Yang D, Wheeler M, Karanth SD, Aduse-Poku L, Leeuwenburgh C, Anton S, Guo Y, Bian J, Liang M, Yoon HS, Akinyemiju T, Braithwaite D, Zhang D. Allostatic load and risk of all-cause, cancer-specific, and cardiovascular mortality in older cancer survivors: an analysis of the National Health and Nutrition Examination Survey 1999-2010. AGING AND CANCER 2023; 4:74-84. [PMID: 37576467 PMCID: PMC10421616 DOI: 10.1002/aac2.12064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background Allostatic load has been linked to an increased risk of death in various populations. However, to date, there is no research specifically investigating the effect of allostatic load on mortality in older cancer survivors. Aims To investigate the association between allostatic load (AL) and mortality in older cancer survivors. Method A total of 1,291 adults aged 60 years or older who survived for ≥1 year since cancer diagnoses were identified from the 1999-2010 National Health and Nutrition Examination Survey. AL was the exposure of interest incorporating 9 clinical measures/biomarkers; one point was added to AL if any of the measures/biomarkers exceeded the normal level. The sum of points was categorized as an ordinal variable to reflect low, moderate, and high AL. Our outcomes of interest were all-cause, cancer-specific, and cardiovascular disease (CVD)-specific mortality. Death was identified by linkage to the National Death Index. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratio (aHR) and 95% confidence intervals (CI) of mortality by AL category. Results Overall, 53.6% of participants were male and 78.4% were white. The mean age of study participants at interview was 72.8 years (SD=7.1). A total of 546 participants died during the follow-up (median follow-up time: 8.0 years). Among them, 158 died of cancer and 106 died of cardiovascular events. Results from multivariable Cox proportional hazards models showed that higher ALS was positively associated with higher all-cause mortality (ALS=4-9 vs. ALS =0-1: aHR=1.52, 95% CI =1.17-1.98, p-trend<0.01) and higher cancer-specific mortality (ALS=4-9 vs. ALS =0-1: aHR=1.80, 95% CI =1.12-2.90, p-trend=0.01). The association between ALS and cardiovascular mortality was positive but non-significant (ALS=4-9 vs. ALS =0-1: aHR=1.59, 95% CI =0.86-2.94, p-trend=0.11). Conclusions Our study suggests that older cancer survivors can have a higher risk of death if they have a high burden of AL.
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Affiliation(s)
- Danting Yang
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL
| | - Meghann Wheeler
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL
| | - Shama D. Karanth
- Department of Aging & Geriatric Research, University of Florida College of Medicine, Gainesville, FL
- University of Florida Health Cancer Center, Gainesville, FL
| | - Livingstone Aduse-Poku
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL
| | - Christiaan Leeuwenburgh
- Department of Aging & Geriatric Research, University of Florida College of Medicine, Gainesville, FL
| | - Stephen Anton
- Department of Aging & Geriatric Research, University of Florida College of Medicine, Gainesville, FL
| | - Yi Guo
- University of Florida Health Cancer Center, Gainesville, FL
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Jiang Bian
- University of Florida Health Cancer Center, Gainesville, FL
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL
| | - Muxuan Liang
- Department of Biostatistics, University of Florida College of Public Health and Health Professions, Gainesville, FL
| | - Hyung-Suk Yoon
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Tomi Akinyemiju
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC
- Duke Cancer Institute, School of Medicine, Duke University, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Dejana Braithwaite
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
- University of Florida Health Cancer Center, Gainesville, FL
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Tonkikh O, Chi NC, Herr KA, Fishman SM, Young HM. Supporting the Health and Well-Being of Caregivers of Persons with Pain. Am J Nurs 2023; 123:55-61. [PMID: 37233141 DOI: 10.1097/01.naj.0000938740.48023.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Orly Tonkikh
- Orly Tonkikh is a Heather M. Young Postdoctoral Fellow at the Betty Irene Moore School of Nursing at the University of California, Davis, in Sacramento. Nai-Ching Chi is an assistant professor in the College of Nursing at the University of Iowa in Iowa City, where Keela A. Herr is the Kelting Professor in Nursing, associate dean for faculty, and codirector of the Csomay Center for Gerontological Excellence. Scott M. Fishman is a professor, the Anderson Endowed Chair in Wellness, the Fullerton Endowed Chair in Pain Medicine, and executive vice chair in the Department of Anesthesiology and Pain Medicine at the University of California, Davis, School of Medicine in Sacramento, where he is also executive director of the Office of Wellness Education and director of the Center for Advancing Pain Relief. Heather M. Young is a professor and founding dean emerita in the Betty Irene Moore School of Nursing at the University of California, Davis, and national director of the Betty Irene Moore Fellowship for Nurse Leaders and Innovators. This work was funded by the Mayday Fund and the Ralph C. Wilson, Jr. Foundation. Contact author: Orly Tonkikh, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Juster RP, Misiak B. Advancing the allostatic load model: From theory to therapy. Psychoneuroendocrinology 2023:106289. [PMID: 37202225 DOI: 10.1016/j.psyneuen.2023.106289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Robert-Paul Juster
- Research Center of the Montreal Mental Health University Institute, Canada; Department of Psychiatry and Addiction, University of Montreal, Canada.
| | - Blazej Misiak
- Department and Clinic of Psychiatry, Wroclaw Medical University, Poland
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27
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Cullin JM. Biological normalcy and body fat: Obesity prevalence, fat stigma, and allostatic load among late adolescents and young adults. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023. [PMID: 37096804 DOI: 10.1002/ajpa.24752] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/17/2023] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES Biological normalcy provides a framework to assess tensions between clinical definitions of "normal," statistical norms, and normative beliefs. A prevailing cultural belief is obesity directly causes poor health, but research has demonstrated consequences of fat stigma. Previous research linked fat stigma and allostatic load (AL) in adults, but this has not been demonstrated in youth, and the role of obesity prevalence is unknown. This study assesses the relationship between fat stigma and AL among youth from counties varying by obesity prevalence. MATERIALS AND METHODS Undergraduates from 38 counties across the US state of Indiana (n = 175) were recruited. Fat stigma was measured using the brief stigmatizing situations inventory (SSI). AL was calculated using eight biomarkers representing cardiovascular, metabolic, and immune function. Poisson regression assessed relationships of interest and adjusted for potential confounding. An interaction term and stratified analyses were used to assess moderation. RESULTS SSI was not statistically associated with obesity prevalence (RR = 0.96, p = 0.173) but did statistically significantly predict AL (RR = 1.019, p = 0.045) when adjusting for confounders. Obesity prevalence moderated the relationship between SSI and AL (RR = 0.993, p = 0.001). DISCUSSION Results suggest that fat stigma, regardless of body fat percentage, is associated with physiologic wear and tear on the late adolescent body, and that exposure to obesity during earlier adolescence moderates this relationship. Those most at risk for high AL reported high fat stigma and lived in counties with relatively low obesity prevalence during earlier adolescence, suggesting vulnerability to fat stigma may be heightened where obesity is less common.
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Affiliation(s)
- Jennifer M Cullin
- Department of Anthropology, Indiana University, Bloomington, Indiana, USA
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28
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Chubar V, Vaessen T, Noortgate WVD, Lutin E, Bosmans G, Bekaert B, Van Leeuwen K, Calders F, Weyn S, Bijttebier P, Goossens L, Claes S. Mild daily stress, in interaction with NR3C1 DNA methylation levels, is linked to alterations in the HPA axis and ANS response to acute stress in early adolescents. Psychoneuroendocrinology 2023; 150:106045. [PMID: 36796155 DOI: 10.1016/j.psyneuen.2023.106045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Daily Hassles (DH) or daily stress - is a mild type of stressor with unique contributions to psychological distress. Yet, most prior studies that investigate the effects of stressful life experiences focus on childhood trauma or on early life stress and little is known about the effects of DH on epigenetic changes in stress system related genes and on the physiological response to social stressors. METHODS In the present study, conducted among 101 early adolescents (mean age = 11.61; SD = 0.64), we investigated whether Autonomic Nervous System (ANS) (namely heart rate and heart rate variability) and Hypothalamic-Pituitary-Adrenal (HPA) axis functioning (measured as cortisol stress reactivity and recovery) are associated with DNA methylation (DNAm) in the glucocorticoid receptor gene (NR3C1), the level of DH and their interaction. To assess the stress system functioning the TSST protocol was used. RESULTS Our findings show that higher NR3C1 DNAm in interaction with higher levels of daily hassles, is associated with blunted HPA axis reactivity to psychosocial stress. In addition, higher levels of DH are associated with extended HPA axis stress recovery. In addition, participants with higher NR3C1 DNAm had lower ANS adaptability to stress, specifically lower parasympathetic withdrawal; for heart rate variability this effect was strongest for participants with higher level of DH. CONCLUSIONS The observation that interaction effects between NR3C1 DNAm levels and daily stress on the functioning of the stress-systems, are already detectable in young adolescents, highlights the importance of early interventions, not only in the case of trauma, but also daily stress. This might help to prevent stress-induced mental and physical disorders later in life.
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Affiliation(s)
- Viktoria Chubar
- Mind-Body Research Group, Department of Neuroscience, KU Leuven, Leuven, Belgium.
| | - Thomas Vaessen
- Mind-Body Research Group, Department of Neuroscience, KU Leuven, Leuven, Belgium; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Wim Van den Noortgate
- Methodology of Educational Sciences, Faculty of Psychology and Educational Sciences & itec, an imec research group at KU Leuven, Leuven, Belgium
| | - Erika Lutin
- ESAT Electrical Engineering, KU Leuven, Leuven, Belgium; imec-Belgium, Heverlee, Belgium
| | - Guy Bosmans
- Department of Clinical Psychology, KU Leuven, Belgium
| | - Bram Bekaert
- Department of Forensic Medicine, Laboratory of Forensic Genetics and Molecular Archaeology, KU Leuven, Leuven, Belgium; Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Karla Van Leeuwen
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Filip Calders
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Sofie Weyn
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Patricia Bijttebier
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Luc Goossens
- School Psychology and Child and Adolescent Development Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Stephan Claes
- Mind-Body Research Group, Department of Neuroscience, KU Leuven, Leuven, Belgium; University Psychiatric Center KU Leuven, Leuven, Belgium
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Slusher AL, Acevedo EO. Stress induced proinflammatory adaptations: Plausible mechanisms for the link between stress and cardiovascular disease. Front Physiol 2023; 14:1124121. [PMID: 37007994 PMCID: PMC10065149 DOI: 10.3389/fphys.2023.1124121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023] Open
Abstract
Initiating from Hans Selye’s conceptualization of stress physiology, to our present understanding of allostatic load as the cumulative burden of chronic psychological stress and life events, investigators have sought to identify the physiological mechanisms that link stress to health and disease. Of particular interest has been the link between psychological stress and cardiovascular disease (CVD), the number one cause of death in the United States. In this regard, attention has been directed toward alterations in the immune system in response to stress that lead to increased levels of systemic inflammation as a potential pathway by which stress contributes to the development of CVD. More specifically, psychological stress is an independent risk factor for CVD, and as such, mechanisms that explain the connection of stress hormones to systemic inflammation have been examined to gain a greater understanding of the etiology of CVD. Research on proinflammatory cellular mechanisms that are activated in response to psychological stress demonstrates that the ensuing low-grade inflammation mediates pathways that contribute to the development of CVD. Interestingly, physical activity, along with its direct benefits to cardiovascular health, has been shown to buffer against the harmful consequences of psychological stress by “toughening” the SAM system, HPA axis, and immune system as “cross-stressor adaptations” that maintain allostasis and prevent allostatic load. Thus, physical activity training reduces psychological stress induced proinflammation and attenuates the activation of mechanisms associated with the development of cardiovascular disease. Finally, COVID-19 associated psychological stress and its associated health risks has provided another model for examining the stress-health relationship.
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Affiliation(s)
- Aaron L. Slusher
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
- Department of Athletics, Yale University, New Haven, CT, United States
- *Correspondence: Aaron L. Slusher,
| | - Edmund O. Acevedo
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA, United States
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Siew RVK, Bowe SJ, Turner AI, Sarnyai Z, Nilsson CJ, Shaw JE, Magliano DJ, Torres SJ. The role of combined modifiable lifestyle behaviors in the longitudinal association between stressful life events and allostatic load in Australian adults. Psychoneuroendocrinology 2023; 149:106021. [PMID: 36610209 DOI: 10.1016/j.psyneuen.2022.106021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Abstract
Allostatic load is a model that is used to quantify the physiological damage from exposure to stressors. Stressful life events are chronic stressors that can lead to an elevated allostatic load through the physiological and behavioral stress responses. However, there is limited empirical studies that has tested the proposed behavioural pathway. Our study addresses this gap by examining the mediating role of combined modifiable lifestyle behaviors in the 12-years longitudinal association between stressful life events and allostatic load among participants from the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study cohort. A latent profile analysis was performed to identify latent subgroups with distinct behavioral clusters based on five modifiable lifestyle behaviors (smoking, sedentary behavior, physical activity, alcohol consumption, and diet quality). We then used a sequential mediation model design with path analysis to test the mediating effect of these latent subgroups in the associations between stressful life events and three measures of allostatic load. Indirect effects were estimated using the product of coefficient approach and the statistical significance was determined by the 95% bias-corrected bootstrap confidence intervals with 1000 replications. We identified three latent subgroups: "least healthy lifestyle" (12%; n = 396), "moderately healthy lifestyle" (78.7%; n = 2599), and "most healthy lifestyle" (9.2%; n = 306). Exposure to stressful life events was not associated with the allocation of participants in latent subgroups. Compared to the "moderately healthy lifestyle" subgroups, we found that the "least healthy lifestyle" behavioral cluster was not associated with allostatic load. However, there was a significant inverse association between the "most healthy lifestyle" behavioral cluster and allostatic load. Overall, we did not find significant indirect effects between stressful life events and three measures of allostatic load via the "least healthy lifestyle" and the "most healthy lifestyle" groups. In summary, the combinations of modifiable lifestyle behaviors did not explain the association between stressful life events and allostatic load. More longitudinal studies are needed to replicate our study to confirm this finding.
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Affiliation(s)
- Raymond Vooi Khong Siew
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.
| | - Steven J Bowe
- Deakin Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Anne I Turner
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Zoltán Sarnyai
- College of Public Health, Medical and Veterinary Sciences, Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville, Australia
| | - Charlotte Juul Nilsson
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Susan J Torres
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Prevalence of Potentially Inappropriate Prescriptions According to the New STOPP/START Criteria in Nursing Homes: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11030422. [PMID: 36766997 PMCID: PMC9914658 DOI: 10.3390/healthcare11030422] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
The demand for long-term care is expected to increase due to the rising life expectancy and the increased prevalence of long-term illnesses. Nursing home residents are at an increased risk of suffering adverse drug events due to inadequate prescriptions. The main objective of this systematic review is to collect and analyze the prevalence of potentially inadequate prescriptions based on the new version of STOPP/START criteria in this specific population. Databases (PubMed, Web of Science and Cochrane) were searched for inappropriate prescription use in nursing homes according to the second version of STOPP/START criteria. The risk of bias was assessed with the STROBE checklist. A total of 35 articles were assessed for eligibility. One hundred and forty nursing homes and more than 6900 residents were evaluated through the analysis of 13 studies of the last eight years. The reviewed literature returned prevalence ranges between 67.8% and 87.7% according to the STOPP criteria, according to START criteria prevalence ranged from 39.5% to 99.7%. The main factors associated with the presence of inappropriate prescriptions were age, comorbidities, and polypharmacy. These data highlight that, although the STOPP/START criteria were initially developed for community-dwelling older adults, its use in nursing homes may be a starting point to help detect more efficiently inappropriate prescriptions in institutionalized patients. We hope that this review will help to draw attention to the need for medication monitoring systems in this vulnerable population.
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Longitudinal associations between allostatic load, pet ownership, and socioeconomic position among U.S. adults aged 50. SSM Popul Health 2023; 21:101344. [PMID: 36684398 PMCID: PMC9853381 DOI: 10.1016/j.ssmph.2023.101344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/15/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
It is hypothesized that pets provide benefits to human health by buffering the deleterious effects of stress, but varying exposure to chronic stress via social position is rarely considered in these conceptual and empirical models. Allostatic load is an index of biological and physical measures that represents cumulative wear and tear on the body via chronic stress exposure. In this study, we use the 2006-2016 waves of the Health and Retirement Study, a nationally representative, longitudinal panel survey of adults aged 50+ in the United States, to test whether and to what extent pet ownership has an impact on allostatic load, and whether pet ownership moderates the effects of socioeconomic position on allostatic load. Linear mixed effects regression models revealed that pet owners had significantly lower allostatic load scores than those who do not own pets; however, after adjusting for socioeconomic position (i.e., wealth, education, race, ethnicity, gender, marital status), the effect of pet ownership was no longer significant. We estimated a series of models stratified by sociodemographic groups to test moderation effects. Among those who had a high school education, pet owners had lower allostatic load scores, whereas among those who had attended some college, pet owners had higher scores. Among those who were aged 80+, pet owners had higher scores than those who did not own pets. These findings suggest that the magnitude of the effect of pet ownership on allostatic load may not be sufficient to counteract experiences of high chronic stress as experienced by lower-status groups. Supporting the human-animal bond may contribute to improving older adult population health if paired with efforts to address the underlying causes of population health disparities.
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Beese S, Postma J, Graves JM. Allostatic Load Measurement: A Systematic Review of Reviews, Database Inventory, and Considerations for Neighborhood Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192417006. [PMID: 36554888 PMCID: PMC9779615 DOI: 10.3390/ijerph192417006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods. METHODS This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term "allostatic load" in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews. RESULTS The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden. CONCLUSIONS The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.
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Affiliation(s)
- Shawna Beese
- College of Agricultural, Human, and Natural Resources Sciences, Washington State University, Pullman, WA 99164, USA
- College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - Julie Postma
- College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - Janessa M. Graves
- College of Nursing, Washington State University, Spokane, WA 99202, USA
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Longpré-Poirier C, Dougoud J, Jacmin-Park S, Moussaoui F, Vilme J, Desjardins G, Cartier L, Cipriani E, Kerr P, Le Page C, Juster RP. Sex and Gender and Allostatic Mechanisms of Cardiovascular Risk and Disease. Can J Cardiol 2022; 38:1812-1827. [PMID: 36150584 DOI: 10.1016/j.cjca.2022.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular diseases are leading causes of mortality and morbidity in adults worldwide. Multiple studies suggest that there are clinically relevant sex differences in cardiovascular disease. Women and men differ substantially in terms of prevalence, presentation, management, and outcomes of cardiovascular disease. To date, however, little is known about why cardiovascular disease affects women and men differently. Because many studies do not differentiate the concept of sex and gender, it is sometimes difficult to discriminate sociocultural vs biological contributors that drive observed clinical differences. Female sex has some biological advantages in relation to cardiovascular disease, but many of these advantages seem to disappear as soon as women develop cardiovascular risk factors (eg, type 2 diabetes, hypertension, dyslipidemia). Furthermore, stress and allostatic load could play an important role in the relationship between sex/gender and cardiovascular diseases. In this narrative review, we argue that chronic stress and psychosocial factors might better encompass the patterns of allostatic load increases seen in women, while biological risk factors and unhealthy behaviours might be more important mechanisms that drive increased allostatic load in men. Indeed, men show allostatic load patterns that are more associated with impaired anthropometric, metabolic, and cardiovascular functioning and women have greater dysregulation in neuroendocrine and immune functioning. Thus gender-related factors might contribute to the pathogenesis of cardiovascular disease especially through stress mechanisms. It is important to continue to study the mechanisms by which gender influences chronic stress, because chronic stress could influence modifiable gendered factors to promote cardiovascular disease prevention.
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Affiliation(s)
- Christophe Longpré-Poirier
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada.
| | - Jade Dougoud
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Silke Jacmin-Park
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Fadila Moussaoui
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada
| | - Joanna Vilme
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Gabriel Desjardins
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychology, University of Montréal, Montréal, Québec, Canada
| | - Louis Cartier
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
| | - Enzo Cipriani
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
| | - Philippe Kerr
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
| | - Cécile Le Page
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada
| | - Robert-Paul Juster
- Research Centre, University Institute of Mental Health at Montréal, University of Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addiction, University of Montréal, Montréal, Québec, Canada
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Choo S, Kim R, Lee H, Yi H, Kim R, Kim SS. Association between discrimination and poor sleep health outcomes among 2192 South Korean gay, lesbian, and bisexual adults: A nationwide cross-sectional survey. Sleep Health 2022; 8:587-592. [PMID: 36220734 DOI: 10.1016/j.sleh.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The study aimed to assess the prevalence of poor sleep health outcomes and examine the associations between experiences of discrimination and the sleep health outcomes among lesbian, gay, and bisexual (LGB) adults in Korea. DESIGN & SETTING The study used data from Rainbow Connection Project I, a nationwide cross-sectional survey of Korean LGB adults, conducted via online in 2016. MEASUREMENTS Participants were asked about experiences of anti-LGB discrimination and discrimination based on other characteristics (ie, gender, age, place of origin, nationality/race, religion, appearance including height and weight, disability status, and other) in the past 12 months. Using the responses, the participants were categorized into 4 groups: those who experienced (1) none, (2) only anti-LGB discrimination, (3) only other types of discrimination, and (4) both anti-LGB and other types of discrimination. Past-week sleep quality, unrestful sleep, and long sleep latency were included as sleep health outcomes. RESULTS Of the 2192 participants, 740 (33.8%) had poor sleep quality, 1211 (55.2%) had unrestful sleep, and 681 (31.1%) had long sleep latency in the past week. Participants who experienced both anti-LGB and other types of discrimination had 1.65 times (95% confidence interval [CI] = 1.38-1.98), 1.30 times (95% CI = 1.16-1.45), and 1.58 times (95% CI = 1.31-1.90) higher prevalence of poor sleep quality, unrestful sleep, and long sleep latency, respectively, compared to those without any experiences of discrimination. CONCLUSIONS Experiencing discrimination may deprive Korean LGB adults of good quality sleep. Interventions that seek to prevent discrimination are needed to promote sleep health among Korean LGB individuals.
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Affiliation(s)
- Sungsub Choo
- Department of Public Health Sciences, Interdisciplinary Program in Precision Public Health, Graduate School of Korea University, Seoul, South Korea; Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Ranyeong Kim
- Department of Public Health Sciences, Interdisciplinary Program in Precision Public Health, Graduate School of Korea University, Seoul, South Korea; Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
| | - Hyemin Lee
- Jeju Institute of Public Health & Health Policy, Jeju, South Korea
| | - Horim Yi
- Solidarity for LGBT Human Rights of Korea, Seoul, South Korea
| | - Rockli Kim
- Department of Public Health Sciences, Interdisciplinary Program in Precision Public Health, Graduate School of Korea University, Seoul, South Korea; Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
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Touma F, Hummer RA. Race/ethnicity, immigrant generation, and physiological dysregulation among U.S. adults entering midlife. Soc Sci Med 2022; 314:115423. [PMID: 36283331 PMCID: PMC10112471 DOI: 10.1016/j.socscimed.2022.115423] [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: 05/09/2022] [Revised: 08/29/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
This study aimed to better understand racial/ethnic and immigrant generation disparities in physiological dysregulation in the early portion of the adult life course. Using biomarker-measured allostatic load, we focused on the health of child/adolescent immigrant, second-, and third-plus-generation Asian, Black, Hispanic, and White Americans in their late 30s and early 40s. We drew on restricted-access data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), Waves I and V. The results indicate lower levels of physiological dysregulation for most racial/ethnic groups of child/adolescent immigrants relative to both third-plus-generation Whites and third-plus-generation same race/ethnic peers. Socioeconomic, social, and behavioral control variables measured in different parts of the life course had little impact on these patterns. Thus, evidence of an immigrant health advantage is found for this cohort using allostatic load as a measure of physiological dysregulation, even though immigrants in Add Health arrived at the United States during childhood and adolescence. Implications of these findings in the context of immigrant health advantages and trajectories are discussed.
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Affiliation(s)
- Fatima Touma
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Pauli Murray Hall, CB #3210, Chapel Hill, NC 27599-3210, USA; Carolina Population Center, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27516-2524, USA.
| | - Robert A Hummer
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Pauli Murray Hall, CB #3210, Chapel Hill, NC 27599-3210, USA; Carolina Population Center, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27516-2524, USA
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Desjardins G, Caceres BA, Juster RP. Sexual minority health and allostatic load in the National Health and Nutrition Examination Survey: A systematic scoping review with intersectional implications. Psychoneuroendocrinology 2022; 145:105916. [PMID: 36115322 DOI: 10.1016/j.psyneuen.2022.105916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
Understood largely from a minority stress framework, sexual minorities (SM) are hypothesized to suffer more physical and mental health burdens compared to their heterosexual counterparts. Several studies have used data from the National Health and Nutrition Examination Survey (NHANES) in the United States to assess SM health disparities and the 'wear and tear' of allostatic load. Because findings are generally mixed and sometimes contradictory with sexual minority stress theory, we endeavoured to explore existing NHANES studies of SM health. Our scoping review yielded a comprehensive analysis of all existing published articles (N = 43) that have used the NHANES to assess any outcome regarding SM health and well-being. Our synthesis confirms that SM sub-groups are significantly different from one another and from their heterosexual peers on several key health variables. Surprisingly, gay men appear to have the lowest allostatic load and no differences have yet been identified among women as a function of sexual identity/behavior. The existing literature suggests a need to use the NHANES more broadly and to include more psychosocial variables to better delineate sexual minority stress. This is especially important to consider at a physiological level in allostatic load research that should better include health behaviors available in NHANES and from other available datasets as moderators linking psychosocial exposures (e.g., minority stress) and health outcomes. Suggested future directions are proposed in an intersectional perspective that incorporates interactions among sex, gender, sexual identity/behaviors, race, ethnicity, age cohorts, socioeconomic status, and lived experiences.
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Affiliation(s)
- Gabriel Desjardins
- Center on Sex⁎Gender, Allostasis, and Resilience (CÉSAR), Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada.
| | - Billy A Caceres
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, NY, USA
| | - Robert-Paul Juster
- Center on Sex⁎Gender, Allostasis, and Resilience (CÉSAR), Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
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DeCaro JA, Helfrecht C. Applying minimally invasive biomarkers of chronic stress across complex ecological contexts. Am J Hum Biol 2022; 34:e23814. [PMID: 36201446 PMCID: PMC9788276 DOI: 10.1002/ajhb.23814] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023] Open
Abstract
Chronic stress is both theoretically and methodologically challenging to operationalize through biomarkers. Yet minimally invasive, field-friendly biomarkers of chronic stress are valuable in research linking biology and culture, seeking to understand differential patterns of human development across ecological contexts, and exploring the evolution of human sociality. For human biologists, a central question in measurement and interpretation of biomarkers is how stress-responsive physiological systems are regulated across diverse human ecologies. This article aims to describe a conditional toolkit for human biologists interested in the study of chronic stress, highlighting a mix of longstanding and novel biomarkers, with special focus on hair/fingernail cortisol, latent herpesvirus antibodies, allostatic load indices, and serial/ambulatory data collection approaches. Future trends in chronic stress biomarker research, including epigenetic approaches, are briefly considered. This overview considers: (1) challenges in separating a distinctly psychosocial dimension of chronic stress from adversity more broadly; (2) essential characteristics of human ecology that shape interpretation; (3) retrospective vs. longitudinal sampling; (4) the role of age, developmental effects, and local biologies; (5) different timescales of chronicity; and (6) the role of culture.
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Affiliation(s)
- Jason A. DeCaro
- Department of AnthropologyThe University of AlabamaTuscaloosaAlabamaUSA
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Rich T, Chrisinger BW, Kaimal R, Winter SJ, Hedlin H, Min Y, Zhao X, Zhu S, You SL, Sun CA, Lin JT, Hsing AW, Heaney C. Contemplative Practices Behavior Is Positively Associated with Well-Being in Three Global Multi-Regional Stanford WELL for Life Cohorts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13485. [PMID: 36294068 PMCID: PMC9603492 DOI: 10.3390/ijerph192013485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Positive associations between well-being and a single contemplative practice (e.g., mindfulness meditation) are well documented, yet prior work may have underestimated the strength of the association by omitting consideration of multiple and/or alternative contemplative practices. Moreover, little is known about how contemplative practice behavior (CPB) impacts different dimensions of well-being. This study investigates the relationship of CPB, consisting of four discrete practices (embodied somatic-observing, non-reactive mindfulness, self-compassion, and compassion for others), with multiple dimensions of well-being. As with other canonical lifestyle behaviors, multiple contemplative practices can be integrated into one's daily routine. Thus, it is critical to holistically consider these behaviors, extending them beyond a simple uni-dimensional measure (e.g., daily mindfulness meditation practice). We developed an integrative measure of four types of contemplative practice and found it to be significantly associated with a multi-dimensional measure of well-being. Importantly, our findings were from three large global multi-regional cohorts and compared against better-understood lifestyle behaviors (physical activity). Data were drawn from California/San Francisco Bay Area, (n = 6442), Hangzhou City (n = 10,268), and New Taipei City (n = 3033). In all three cohorts, we found statistically significant (p < 0.05) positive associations between CPB and well-being, both overall and with all of the constituent domains of well-being, comparable to or stronger than the relationship with physical activity across most well-being outcomes. These findings provide robust and cross-cultural evidence for a positive association between CPB and well-being, illuminate dimensions of well-being that could be most influenced by CPB, and suggest CPB may be useful to include as part of fundamental lifestyle recommendations for health and well-being.
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Affiliation(s)
- Tia Rich
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA 94035, USA
| | | | | | - Sandra J. Winter
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA 94035, USA
| | - Haley Hedlin
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA 94035, USA
| | - Yan Min
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA 94035, USA
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Xueyin Zhao
- Chronic Disease Research Institute, The Children’s Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Shankuan Zhu
- Chronic Disease Research Institute, The Children’s Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - San-Lin You
- School of Medicine, Data Science Center, College of Medicine Fu-Jen Catholic University, New Taipei City 24205, Taiwan
| | - Chien-An Sun
- School of Medicine, Data Science Center, College of Medicine Fu-Jen Catholic University, New Taipei City 24205, Taiwan
| | - Jaw-Town Lin
- Department of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung City 82445, Taiwan
| | - Ann W. Hsing
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA 94035, USA
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford School of Medicine, Stanford University, Stanford, CA 94035, USA
| | - Catherine Heaney
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA 94035, USA
- Department of Psychology, Stanford University, Stanford, CA 94305, USA
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Hill M, Obeng-Gyasi E. The Association of Cytomegalovirus IgM and Allostatic Load. Diseases 2022; 10:diseases10040070. [PMID: 36278569 PMCID: PMC9590072 DOI: 10.3390/diseases10040070] [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: 08/30/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Cytomegalovirus (CMV) is a deoxyribonucleic acid virus that affects a significant proportion of the worldwide population; after primary infection, it goes into a latent state and can be reactivated, primarily after a reduction in host immune defenses. Methods: This study evaluated the association of acute cytomegalovirus infection (CMV IgM) and Allostatic Load (AL) by sociodemographic factors using data from the National Health and Nutrition Examination Survey (NHANES) 2001–2004 among participants (aged 20–49 years). CMV infection was determined by the level of CMV IgM antibody in serum samples. AL was assessed as a combination of 10 biomarkers from the cardiovascular, inflammatory, and metabolic systems. The evaluation of the association between CMV infection and AL included descriptive statistics and logistic regression models, which were adjusted for demographic and behavioral covariates. Results: AL was more elevated among those who were older, male, those with lower education, those performing limited physical activity, and smokers. CMV was more elevated in females than males among those who consumed alcohol and cigarette smokers. In Pearson’s correlation analysis, there was a slight positive correlation between CMV IgM and AL, with triglycerides and Body Mass Index (BMI) the most strongly correlated with AL. Binary logistic regression showed no significant relationship between high AL and positive CMV IgM but did show a significant relationship between high AL and age (OR = 1.0592, 95% CI 1.0215–1.0983, p = 0.00715). The findings of this study provide insight into the relationship between CMV and AL and provide awareness of factors that affect their relationship.
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Affiliation(s)
- Matthew Hill
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Emmanuel Obeng-Gyasi
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
- Correspondence: ; Tel.: +1-336-285-3132
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Ghelli F, Panizzolo M, Garzaro G, Squillacioti G, Bellisario V, Colombi N, Bergamaschi E, Guseva Canu I, Bono R. Inflammatory Biomarkers in Exhaled Breath Condensate: A Systematic Review. Int J Mol Sci 2022; 23:ijms23179820. [PMID: 36077213 PMCID: PMC9456215 DOI: 10.3390/ijms23179820] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 01/08/2023] Open
Abstract
Inflammation is a comprehensive set of physiological processes that an organism undertakes in response to a wide variety of foreign stimuli, such as viruses, bacteria, and inorganic particles. A key role is played by cytokines, protein-based chemical mediators produced by a broad range of cells, including the immune cells recruited in the inflammation site. The aim of this systematic review is to compare baseline values of pro/anti-inflammatory biomarkers measured in Exhaled Breath Condensate (EBC) in healthy, non-smoking adults to provide a summary of the concentrations reported in the literature. We focused on: interleukin (IL)-1β, IL-4, IL-6, IL-8, IL-10, tumour necrosis factor-alpha (TNF-α), and C reactive protein (CRP). Eligible articles were identified in PubMed, Embase, and Cochrane CENTRAL. Due to the wide differences in methodologies employed in the included articles concerning EBC sampling, storage, and analyses, research protocols were assessed specifically to test their adherence to the ATS/ERS Task Force guidelines on EBC. The development of reference intervals for these biomarkers can result in their introduction and use in both research and clinical settings, not only for monitoring purposes but also, in the perspective of future longitudinal studies, as predictive parameters for the onset and development of chronic diseases with inflammatory aetiology.
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Affiliation(s)
- Federica Ghelli
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Marco Panizzolo
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Giacomo Garzaro
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Giulia Squillacioti
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Valeria Bellisario
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Nicoletta Colombi
- Federated Library of Medicine “F. Rossi”, University of Turin, 10126 Turin, Italy
| | - Enrico Bergamaschi
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
- Correspondence:
| | - Irina Guseva Canu
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1066 Lausanne, Switzerland
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
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Xu H, Yang T, Guo B, Silang Y, Dai Y, Baima K, Gao Y, Tang S, Wei J, Jiang Y, Feng S, Li S, Xiao X, Zhao X. Increased allostatic load associated with ambient air pollution acting as a stressor: Cross-sectional evidence from the China multi-ethnic cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 831:155658. [PMID: 35523330 DOI: 10.1016/j.scitotenv.2022.155658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Allostatic load measures the cumulative biological burden imposed by chronic stressors. Emerging experimental evidence supports that air pollution acting as a stressor activates the neuroendocrine system and then produces multi-organ effects, leading to allostatic load. However, relevant epidemiological evidence is limited. OBJECTIVES We aim to explore the relationships between chronic exposure to ambient air pollution (PM1, PM2.5, PM10, and O3) and allostatic load in Chinese adults. METHODS This cross-sectional study included 85,545 participants aged 30-79 from the baseline data of the China Multi-Ethnic Cohort (CMEC). Ambient air pollution levels were evaluated by a satellite-based random forest approach. The previous three-year average exposure concentrations were calculated for each participant based on the residential address. The outcome allostatic load was identified through the sum of the sex-specific scores of twelve biomarkers belonging to four major categories: cardiovascular, metabolic, anthropometric, and inflammatory parameters. We performed statistical analysis using a doubly robust approach which relies on inverse probability weighting and outcome model to adjust for confounding. RESULTS Long-term exposure to ambient air pollution was significantly associated with an increased risk of allostatic load, with relative risk (95% confidence interval) of 1.040 (1.024, 1.057), 1.029 (1. 018, 1. 039), and 1.087 (1.074, 1.101) for each 10 μg/m3 increase in ambient PM2.5, PM10, and O3, respectively. No significant relationship was observed between chronic exposure to PM1 and allostatic load. The associations between air pollution and allostatic load are modified by some intrinsic factors and non-chemical stressors. The people with older, minority, lower education, and lower-income levels had a significantly higher allostatic load induced by air pollution. CONCLUSIONS Chronic exposure to ambient PM2.5, PM10, and O3 may increase the allostatic load. This finding provides epidemiological evidence that air pollution may be a chronic stressor, leading to widespread physiological burdens.
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Affiliation(s)
- Huan Xu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hongkong Polytechnic University, Chengdu, Sichuan, China; West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tingting Yang
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Bing Guo
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yangzong Silang
- Tibet Center for Disease Control and Prevention, Lhasa, Tibet, China
| | - Yingxue Dai
- Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Kangzhuo Baima
- School of Medicine, Tibet University, Lhasa, Tibet, China
| | - Yang Gao
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Simei Tang
- Heqing Center for Disease Control and Prevention, Dali Prefecture, Yunnan, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA
| | - Ye Jiang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shiyu Feng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sicheng Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiong Xiao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Al Mamun A, Rahman MK, Yang Q, Jannat T, Salameh AA, Fazal SA. Predicting the Willingness and Purchase of Travel Insurance During the COVID-19 Pandemic. Front Public Health 2022; 10:907005. [PMID: 35859770 PMCID: PMC9291636 DOI: 10.3389/fpubh.2022.907005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
This study explored the willingness and purchase of travel insurance during the COVID-19 pandemic amongst working adults to ensure their safety and welfare through the lens of the theory of planned behavior. Primary data were gathered from 1,118 working adults across Malaysia and analyzed using the partial least squares structural equation modeling. The study outcomes revealed that attitude toward travel insurance was significantly influenced by insurance literacy, perceived health risk, and health consciousness. The willingness of working adults to purchase travel insurance was highly influenced by attitudes, subjective norms, and perceived behavioral controls but unaffected by perceived product risks. The purchase of travel insurance was positively influenced by the willingness to purchase travel insurance. In fact, travel insurance literacy and perceived health risk should be emphasized amongst working adults to encourage them to purchase travel insurance policies for traveling abroad.
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Affiliation(s)
- Abdullah Al Mamun
- UKM - Graduate School of Business, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | | | - Qing Yang
- UKM - Graduate School of Business, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Taslima Jannat
- UKM - Graduate School of Business, Universiti Kebangsaan Malaysia, Bangi, Malaysia
- *Correspondence: Taslima Jannat
| | - Anas A. Salameh
- College of Business Administration, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Syed Ali Fazal
- Faculty of Business Administration, University of Science and Technology Chittagong, Chittagong, Bangladesh
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The Quality of Life and the Bio-Molecular Profile in Working Environment: A Systematic Review. SUSTAINABILITY 2022. [DOI: 10.3390/su14138100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Working life is characterised by various requirements and degrees of control in meeting these demands. The imbalance of these elements with workers’ resources can result in work-related stress involving the repeated activation of stress response systems. Modifications in the bio-molecular profile may represent a biological signature of individuals’ life experiences and provide evidence on pathways through which such stressors can result in health outcomes. The aim of our systematic review is to characterize the quality of life (QOL) and the bio-molecular profile in the working population, to highlight if the alteration observed might be related to the working conditions. The article query was performed on PubMed, Embase, and Cochrane CENTRAL and results have been presented according to three molecular pathways involved in the stress response: oxidative stress, inflammation, and neuroendocrine activation. The epidemiological sample has been sub-grouped into “clinical” and “non-clinical” populations according to the presence of a diagnosis of psychological disorders. Besides some critical issues, the review highlights the importance of developing a valid array of biological indicators, measurable in non-invasive matrices, sensitive to both derangements from physiological conditions and stress reduction, useful for identifying those groups at higher risk of health outcomes and, eventually, promoting workers’ wellbeing.
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Parker HW, Abreu AM, Sullivan MC, Vadiveloo MK. Allostatic Load and Mortality: A Systematic Review and Meta-Analysis. Am J Prev Med 2022; 63:131-140. [PMID: 35393143 DOI: 10.1016/j.amepre.2022.02.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Allostatic load, a measure of stress-related physiologic dysregulation, is associated with numerous mortality risk factors. This systematic review and meta-analysis examines the relationship between high allostatic load (i.e., increased dysregulation versus low dysregulation) and mortality (cardiovascular disease and all-cause mortality). METHODS Systematic searches of 2 databases conducted in May 2021 yielded 336 unique records; 17 eligible studies (2001-2020) were included. RESULTS High allostatic load was associated with increased risk of all-cause mortality across all the 17 individual studies (hazard ratio=1.08-2.75) and in 6 of 8 studies examining cardiovascular disease mortality (hazard ratio=1.19-3.06). Meta-analyses indicated that high allostatic load was associated with increased risk of all-cause mortality, overall (hazard ratio=1.22, 95% CI=1.14, 1.30, n=10) and across subgroups (hazard ratio=1.11-1.41), and similarly for cardiovascular disease mortality (hazard ratio=1.31, 95% CI=1.10, 1.57, n=6). Although studies were generally of good quality (n=13), heterogeneity was high in most pooled estimates (I2>90%). DISCUSSION In this review of relatively good-quality studies, high allostatic load was associated with an increased mortality risk of 22% for all-cause mortality and 31% for cardiovascular disease mortality. Thus, allostatic load is an emerging and potent modifiable risk factor for all-cause and cardiovascular disease mortality that shows promise as a prognostic indicator for mortality. The heterogeneity in allostatic load assessment across studies highlights the need for standardized measurement. The findings underscore the importance of allostatic load's dynamic nature, which may be especially relevant for mitigating mortality risk in younger adults. Because older adults are oversampled, future allostatic load research should prioritize younger adults and longitudinal monitoring and specific cardiovascular disease mortality risk associations and individualize behavioral and lifestyle targets for reducing allostatic load.
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Affiliation(s)
- Haley W Parker
- Department of Nutrition and Food Sciences, College of Health Sciences, The University of Rhode Island, Kingston, Rhode Island
| | - Alyssa M Abreu
- Department of Nutrition and Food Sciences, College of Health Sciences, The University of Rhode Island, Kingston, Rhode Island
| | - Mary C Sullivan
- College of Nursing, The University of Rhode Island, Providence, Rhode Island
| | - Maya K Vadiveloo
- Department of Nutrition and Food Sciences, College of Health Sciences, The University of Rhode Island, Kingston, Rhode Island.
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Al-Kaylani HM, Loeffler BT, Mott SL, Curry M, Phadke S, van der Plas E. Characterizing Early Changes in Quality of Life in Young Women With Breast Cancer. Front Psychol 2022; 13:871194. [PMID: 35645920 PMCID: PMC9132041 DOI: 10.3389/fpsyg.2022.871194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Younger age at diagnosis is a risk factor for poor health-related quality of life (HRQOL) in long-term breast cancer survivors. However, few studies have specifically addressed HRQOL in young adults with breast cancer (i.e., diagnosed prior to age 40), nor have early changes in HRQOL been fully characterized. Methods Eligible female patients with breast cancer were identified through our local cancer center. To establish HRQOL, patients completed the Functional Assessment of Cancer Therapy-Breast (FACT-B) around diagnosis and 12 months later. Sociodemographic factors, genetic susceptibility to cancer, tumor- and treatment-related factors, and comorbidities (e.g., depression/anxiety) were abstracted from medical records and the local oncology registry. Mixed-effects models were used to identify changes in FACT-B scores during the first year of treatment and to determine whether any demographic/treatment-related factors modulated changes in scores. Results Health-related quality of life in young patients with breast cancer was within normal limits at baseline, with a FACT-B overall well-being score of 108.5 (95% confidence limits [CI] = 103.7, 113.3). Participants reported slight improvements over a 12-month period: FACT-B overall well-being scores increased 6.6 points (95% CI = 2.1, 11.1, p < 0.01), functional well-being improved 3.0 points (95% CI = 2.0, 4.1, p < 0.01), emotional well-being improved 1.9 points (95% CI = 0.9, 2.8, p < 0.01), and physical well-being improved 1.5 points (95% CI = 0.2, 2.8, p = 0.03), on average. Participants with anxiety/depression at baseline reported greater improvements in FACT-B overall well-being (change: 12.9, 95% CI = 6.4, 9.5) and functional well-being (change: 5.2, 95% CI = 3.5, 6.9) than participants who did not have anxiety/depression at baseline (change in FACT-B overall well-being: 4.9, 95% CI = 0.2, 9.7; change in functional well-being: 2.3, 95% CI = 1.1, 3.4). Marital status, reconstructive surgery, and baseline clinical staging were also significantly associated with changes in aspects of HRQOL, although their impact on change was relatively minimal. Conclusion Young women with breast cancer do not report HRQOL concerns during the first year of treatment. Improvements in HRQOL during the first year of treatment may be attributable to a sense of relief that the cancer is being treated, which, in the short run, may outweigh the negative late effects of treatment.
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Affiliation(s)
- Hend M Al-Kaylani
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA, United States
| | - Bradley T Loeffler
- Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, IA, United States
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, IA, United States
| | - Melissa Curry
- Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, IA, United States
| | - Sneha Phadke
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA, United States
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Finlay S, Rudd D, McDermott B, Sarnyai Z. Allostatic load and systemic comorbidities in psychiatric disorders. Psychoneuroendocrinology 2022; 140:105726. [PMID: 35339811 DOI: 10.1016/j.psyneuen.2022.105726] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 12/11/2022]
Abstract
Psychiatric disorders are complex, disabling, and chronic conditions that are often accompanied by one or more systemic medical comorbidities. In this narrative review, we provide an overview of the allostatic load concept, which represents a multi-system dysregulation in response to chronic stress and link it to systemic comorbidities associated with psychiatric disorders. We synthesized published literature gathered using Medline (Ovid), Scopus, and PsychInfo and identified a high frequency of systemic comorbidities for both mood and psychotic disorders. The identified cardiovascular, metabolic, and immune comorbidities may represent the result of chronic wear and tear caused by a complex interaction between chronic psychosocial stress, health risk behaviors, pharmacological stressors, and the biological systems involved in the development of allostatic load. These findings support the notion that psychiatric disorders should be re-conceptualized as systemic disorders, affecting the brain and systemic biological pathways in an interconnected fashion to result in systemic comorbidities. We suggest that the multi-systemic and multi-dimensional approach that drives the allostatic load concept should be considered for understanding comorbidities in vulnerable psychiatric patients.
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Affiliation(s)
- Sabine Finlay
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia
| | - Donna Rudd
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia
| | - Brett McDermott
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Zoltán Sarnyai
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia.
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Bobo WV, Grossardt BR, Virani S, St Sauver JL, Boyd CM, Rocca WA. Association of Depression and Anxiety With the Accumulation of Chronic Conditions. JAMA Netw Open 2022; 5:e229817. [PMID: 35499825 PMCID: PMC9062691 DOI: 10.1001/jamanetworkopen.2022.9817] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Longitudinal associations between comorbid depression and anxiety with the accumulation of chronic illnesses are unclear, and questions remain about the contributions associated with each condition in the increasing prevalence of multimorbidity. OBJECTIVE To compare the risk and rate of accumulating chronic conditions in people with depression, anxiety, and comorbid depression and anxiety vs individuals with neither depression nor anxiety. DESIGN, SETTING, AND PARTICIPANTS This cohort study used the Rochester Epidemiology Project medical records-linkage system to identify residents of Olmsted County, Minnesota, from January 1, 2005, to December 31, 2014, with follow-up ending December 31, 2017. The sample was divided into cohorts anchored at birthday ages of 20, 40, and 60 years. Individuals were classified at anchoring birthday age as having depression alone, anxiety alone, comorbid depression and anxiety, or neither depression nor anxiety (reference group), using electronically extracted diagnosis codes from the International Classification of Diseases, Ninth Revision (ICD-9) in the 5 years before each anchoring birthday. Data were analyzed from August 2020 through November 2021. EXPOSURES Depression alone, anxiety alone, comorbid depression and anxiety, or neither depression nor anxiety (reference group). MAIN OUTCOMES AND MEASURES The main outcome was sex-specific risk, calculated as hazard ratios (HRs) and rates of accumulation, calculated as mean annual incidence rates per 100 person-years, of 15 common chronic conditions within each birthday age cohort through the end of study. RESULTS Among the 40 360 individuals included across all 3 age cohorts, 21 516 (53.3%) were women. After balancing cohorts on race, Hispanic ethnicity, education level, body mass index, smoking status, and calendar year at index birthday, the risk of accumulating chronic conditions was significantly increased among women with depression alone (cohort aged 20 years: HR, 1.20 [95% CI, 1.02-1.42]; cohort aged 40 years: HR, 1.20 [95% CI, 1.10-1.31]; cohort aged 60 years: HR, 1.09 [95% CI, 1.02-1.16]) and women with comorbid depression and anxiety (cohort aged 20 years: HR, 1.60 [95% CI, 1.28-1.99]; cohort aged 40 years: HR, 1.41 [95% CI, 1.21-1.65]; cohort aged 60 years: HR, 1.29 [95% CI, 1.15-1.44]) compared with referent women in the same birthday cohorts and in men with comorbid depression and anxiety compared with referent men in the cohort aged 20 years (HR, 1.77 [95% CI, 1.08-2.91]). For women, the rates of accumulation of conditions were significantly higher across birthday cohorts in the comorbid depression and anxiety group compared with the depression alone group (eg, cohort aged 20 years: difference, 1.2 [95% CI, 0.2-2.1] per 100 person-years) and reference group (eg, cohort aged 20 years: difference, 1.7 [95% CI, 0.9-2.6] per 100 person-years). For men, compared with the reference group, the rates of accumulation of conditions were significantly higher in men with comorbid depression and anxiety in the cohort aged 20 years (difference, 1.4 [95% CI, 0.1-2.6] per 100 person-years) and in men with depression in the cohort aged 40 years (difference, 2.0 [95% CI, 0.8-3.2] per 100 person-years). CONCLUSIONS AND RELEVANCE In this cohort study, the risk of accumulating chronic conditions was increased with depression and comorbid depression and anxiety in women across the age span and in younger men with comorbid depression and anxiety. Compared with women without depression or anxiety, there was a more rapid rate of accumulation of chronic conditions in women with depression and anxiety individually and an even higher rate when depression and anxiety cooccurred.
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Affiliation(s)
- William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic Florida, Jacksonville
| | - Brandon R. Grossardt
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Sanya Virani
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Jennifer L. St Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Cynthia M. Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Walter A. Rocca
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Women’s Health Research Center, Mayo Clinic, Rochester, Minnesota
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Longpré-Poirier C, Juster RP, Miron JP, Kerr P, Cipriani E, Desbeaumes Jodoin V, Lespérance P. Allostatic load as a predictor of response to repetitive transcranial magnetic stimulation in treatment resistant depression: Research protocol and hypotheses. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 10:100133. [PMID: 35755203 PMCID: PMC9216427 DOI: 10.1016/j.cpnec.2022.100133] [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: 12/22/2021] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Treatment resistant depression is challenging because patients who fail their initial treatments often do not respond to subsequent trials and their course of illness is frequently marked by chronic depression. Repetitive transcranial magnetic stimulation (rTMS) is a well-established treatment alternative, but there are several limitations that decreases accessibility. Identifying biomarkers that can help clinicians to reliably predict response to rTMS is therefore necessary. Allostatic load (AL), which represents the 'wear and tear' on the body and brain which accumulates as an individual is exposed to chronic stress could be an interesting staging model for TRD and help predict rTMS treatment response. We propose an open study which aims to test whether patients with a lower pre-treatment AL will have a stronger antidepressant response to 4 week-rTMS treatment. We will also assess the relation between healthy lifestyle behaviors, AL, and rTMS treatment response. Blood samples for AL parameters will be collected before the treatment. The AL indices will summarize neuroendocrine (cortisol, Dehydroepiandrosterone), immune (CRP, fibrinogen, ferritin), metabolic (glycosylated hemoglobin, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, uric acid, body mass index, waist circumference), and cardiovascular (heart rate, systolic and diastolic blood pressure) functioning. Mood assessment (Montgomery-Åsberg Depression Rating Scale and Inventory of Depressive symptomatology) will be measured before the treatment and at two-week intervals up to 4 weeks. With the help of different lifestyle questionnaires, a healthy lifestyle index (i.e., a single score based on lifestyle factors) will be created. We will use linear and logistic regressions to assess AL in relation to changes in mood score. Hierarchical regression will be done in order to assess the association between AL, healthy lifestyle index and mood score. Long-lasting and unsuccessful antidepressant trials may increase the chance of not responding to future trials of antidepressants and it can therefore increase treatment resistance. It is essential to identify reliable biomarkers that can predict treatment responses.
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Affiliation(s)
- Christophe Longpré-Poirier
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada
| | - Robert-Paul Juster
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada
| | - Jean-Philippe Miron
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Kerr
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada
| | - Enzo Cipriani
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada
| | - Véronique Desbeaumes Jodoin
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
| | - Paul Lespérance
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
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Finlay S, Roth C, Zimsen T, Bridson TL, Sarnyai Z, McDermott B. Adverse childhood experiences and allostatic load: A systematic review. Neurosci Biobehav Rev 2022; 136:104605. [PMID: 35278597 DOI: 10.1016/j.neubiorev.2022.104605] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/23/2022] [Accepted: 03/06/2022] [Indexed: 12/21/2022]
Abstract
Adverse Childhood Experiences (ACEs) are stressful and/or traumatic experiences associated with an increased lifetime risk of negative health outcomes. The Allostatic Load (AL) is a measure of multisystem dysregulation, resulted by chronic stress. We systematically reviewed the English language literature on the association between ACEs and AL to identify the clinical risk profile, with the exclusion of reviews and preclinical studies. Searches covered the publication period up to the 1st of February 2022 and identified 25 studies in which ACEs such as maltreatment, abuse, poverty, psychological abuse, and discrimination were investigated in the context of AL. The selected studies used different sets of AL biomarkers resulting in substantial heterogenicity of calculating the AL index. Overall, we found that ACEs are associated with elevated AL and poorer health outcomes in adulthood. Furthermore, health risk behaviors, social support, and coping resources either moderate or mediate this association. These findings suggest that targeting individuals at risk and starting interventions early might reduce AL and its deleterious health consequences.
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Affiliation(s)
- Sabine Finlay
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia.
| | - Cody Roth
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia
| | - Tiansha Zimsen
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Tahnee Lee Bridson
- North-West Mental Health, The Royal Melbourne Hospital, Victoria, Australia; Fireside Research, Woodbridge Tasmania, Australia
| | - Zoltan Sarnyai
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia
| | - Brett McDermott
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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