Stress-related health depreciation: Using allostatic load to predict self-rated health

Untapped resource: the simulation-based healthcare environment as a means to study human stress

The effects of 'stress' within the healthcare professions are wide-reaching, not least of all within the field of simulation-based healthcare education. Whilst this popular method of experiential learning offers a 'safe space' for participants to develop their skillset, it also has a more surreptitious action; namely, the incubation of simulation-related stress. Currently, research concerning the complex relationship between stress, learning, and performance is ambiguous, leaving fertile ground for simulationists to debate what level of stress is appropriate for an optimised educational experience. In this narrative review, we examine the human response to stress and outline the various methods that have been used by researchers to measure stress in a quantifiable and standardised way. We then provide a brief overview of simulation-based healthcare education before describing why stress responses have been of interest to healthcare educationalists for some time. Finally, we outline how simulation education environments might provide an ideal environment for studying the human response to stress generally, with ramifications extending beyond the field of medical education.

The Concept of One Health for Allergic Diseases and Asthma

The worldwide prevalence of allergic disease is rising as a result of complex gene-environment interactions that shape the immune system and host response. Climate change and loss of biodiversity are existential threats to humans, animals, plants, and ecosystems. While there is significant progress in the development of targeted therapeutic options to treat allergies and asthma, these approaches are inadequate to meet the challenges faced by climate change. The exposomic approach is needed with the recognition of the bidirectional effect between human beings and the environment. All stakeholders need to work together toward mitigating the effects of climate change and promoting a One Health concept in order to decrease the burden of asthma and allergy and to improve immune health. Healthcare professionals should strive to incorporate One Health counseling, environmental health precepts, and advocacy into their practice.

The Big Five personality traits and allostatic load in middle to older adulthood: A systematic review and meta-analysis

Further understanding of the associations between personality traits and allostatic load (AL) may be important for predicting, addressing, and optimizing health outcomes. This review synthesized the existing literature reporting the association between the Big Five personality traits and AL in adults to identify the generalizability and robustness of relationships, potential mechanisms underlying the associations, and study characteristics that may be contributing to inconsistencies in the field. Published and unpublished empirical reports were included if at least one of the Big Five traits was examined and an AL index was constructed using at least two biomarkers in a sample of adults. The methodological plan and standardized coding guide were pre-registered and reported (https://osf.io/rxw5a). Based on 11 studies that met eligibility, meta-analysis of correlation coefficients indicated a small but significant positive association between neuroticism and AL, and small but significant inverse associations between both conscientiousness and openness with AL. This review identifies strengths and limitations within the field, as well as several avenues for future research.

Biological testing during acute psychological stress: A hindrance or an opportunity?

All humans deal with acute psychological stress periodically. Some individuals are affected by needle phobia in which a heightened sense of arousal is precipitated by venepuncture. Acute psychological stress invokes a range of physiological changes including activation of the sympathetic-adrenal-medullary and hypothalamic-pituitary-adrenal axes. In this review article, we first examine the human response to acute stress. We then provide an overview of how psychological stress in a subject is likely to be a source of pre-analytical variability for certain measurands, and the major biochemical markers that have been studied in research aiming to quantify stress. As such, we highlight how stress can be a hindrance to the accurate interpretation of certain laboratory results (particularly cortisol, prolactin, metanephrines and growth hormone), and point out the role that biochemical analysis might play in future studies looking at the effects of stress on human behaviour.

Toward a conceptual framework of health and its operational definition: an application in the 1958 British birth cohort

BACKGROUND

Defining and measuring Health presents a challenge, partly due to its conceptual pluralism. To measure Health as an ability to adapt and self-manage, we developed an approach within the theoretical framework of resources and reserves over the life course, recently proposed in the literature. We aimed to (i) use the conceptual framework developed to identify indicators of deteriorating health reserves, (ii) construct an overall health measure from these indicators, (iii) evaluate the association between the overall health measure and subsequent health outcomes and (iv) assess the robustness of our method.

METHODS

We used data from 7,043 individuals born in 1958 in Great Britain included in the National Child Development Study. An overall health measure was constructed via the sum of three selected indicators of deteriorating health reserves in mid-life: chronic widespread pain (CWP), Clinical Interview Schedule - revised (CIS-r), and allostatic load (AL). A three-category variable was defined: impaired/medium/optimal overall health. We explored criterion validity by modelling the relationships between the overall health measure, or each reserve taken separately at 44-45 years, and self-rated health at 46 years and mortality up to 58 years, corresponding to 14 years of follow up, using Cox and logistic regressions respectively. We performed comparative analyses to assess the robustness of the method.

RESULTS

Having an impaired overall health measure was significantly associated with all-cause premature mortality (HR_impaired = 2.74 [1.86; 4.05]) and an increased risk of later fair/poor/very poor self-rated health (OR_impaired = 7.50 [6.29; 8.95]). The overall health measure had a greater effect on the self-rated health estimates than each indicator of deteriorating health reserves considered separately (OR_{AL medium} = 1.82 [1.59; 2.09]; OR_{AL high} = 2.74 [2.37; 3.16]; OR_CIS-r = 5.20 [4.45; 6.08]; OR_CWP = 2.85 [2.53; 3.21]). CIS-r and allostatic load were also associated with premature mortality contrary to chronic widespread pain (HR_{AL medium}1.82 [1.27; 2.61]; HR_{AL high} = 3.10 [2.19; 4.40]; HR_CIS-r = 1.77 [1.22; 2.56]; HR_CWP = 1.32 [0.98; 1.76]). The multiple comparative analyses conducted allowed us to assess the robustness of our method within this cohort.

CONCLUSIONS

We proposed a method for measuring Health in mid-life in line with the concept of Health as the ability to adapt and self-manage and the concept of health reserves. This method may be applied and further developed within the field of social and positive epidemiology.