Stress-induced immune dysfunction: implications for health

Chronic stress resulting from stressful life events and its role in the onset of primary Sjögren's syndrome: a comparative analysis using the modified Holmes-Rahe stress scale

Recent years brought considerable attention to the connection between chronic stress and the development of autoimmune diseases. However, little is still known about the impact of prolonged stress reactions on the onset and course of primary Sjögren Syndrome (pSS). This study aimed to seek for associations between chronic stress, resulting from stressful life events, and pSS. In the study, 50 patients with diagnosed pSS, as well as 50 control patients with osteoarthritis underwent an assessment. Modified Holmes-Rahe (H-R) stress scale was used in order to evaluate the impact of stressful events within 12 months prior to the diagnosis. Patients with pSS had a significantly higher total score on H-R stress scale within one-year preceding the disease diagnosis (152 ± 66.3 vs 50 ± 54.6; p <  0.001). Additionally, the pSS patients more commonly than the controls reported a subjectively perceived correlation between stressful events and the occurrence of disease symptoms (50% vs 12%; p <  0.001). Moreover, the H-R score at the time of the assessment correlated with the disease activity. The results support the view that pSS belongs to the group of diseases which pathogenesis is closely related to stressful life events. The novelty of this work lies in focus on both the correlation of stress on the onset of autoimmune disease as well as the activity of previously diagnosed disorder. Our data contributes to finding evidence-based medicine (EBM) arguments to what has until recently been merely a thematic observation-the harmfulness of negative stress on individual's health status.

Drought-compounded stress and immune function in Kenyan pastoralist boys and girls occupying contrasting climate zones

BACKGROUND AND AIM

We provide ethnographic, photovoice, and psychosocial stress data (food and water insecurity, potentially traumatic events, stress biomarkers) documenting the joys, hazards, and stressors of adolescents engaging in climate-sensitive pastoralist livelihoods in a global climate change hot spot. We aim to holistically capture socio-environmental relationships characterised by climate sensitive livelihoods and forms of precarity exacerbated by climate change.

SUBJECTS AND METHODS

Qualitative and quantitative methods were integrated to understand the embodied toll of hazards that Samburu pastoralists faced based on a sample of 161 young people. Quantitatively, we tested for associations of psychosocial stressors with both psychological distress and cell-mediated immune function (assessed through differences in IgG antibodies to Epstein-Barr virus).

RESULTS

Qualitatively, young Samburu reported drought, food and water insecurity, wildlife encounters, and war exposure. Girls overall endorsed more posttraumatic stress symptoms, although boys reported relatively more stressors; girls overall and young people in the hotter subregion manifested more immune dysregulation.

CONCLUSION

In spite of important differences between climate subregions, the common elements throughout the Samburu pastoralist leanscape include food and water insecurity and overall precarity exacerbated by drought and climate change. Community-driven interventions are needed to reduce precarity for young people pursuing pastoralist livelihoods.

Mechanism of N6-Methyladenosine Modification in the Pathogenesis of Depression

N6-methyladenosine (m6A) is one of the most common post-transcriptional RNA modifications, which plays a critical role in various bioprocesses such as immunological processes, stress response, cell self-renewal, and proliferation. The abnormal expression of m6A-related proteins may occur in the central nervous system, affecting neurogenesis, synapse formation, brain development, learning and memory, etc. Accumulating evidence is emerging that dysregulation of m6A contributes to the initiation and progression of psychiatric disorders including depression. Until now, the specific pathogenesis of depression has not been comprehensively clarified, and further investigations are warranted. Stress, inflammation, neurogenesis, and synaptic plasticity have been implicated as possible pathophysiological mechanisms underlying depression, in which m6A is extensively involved. Considering the extensive connections between depression and neurofunction and the critical role of m6A in regulating neurological function, it has been increasingly proposed that m6A may have an important role in the pathogenesis of depression; however, the results and the specific molecular mechanisms of how m6A methylation is involved in major depressive disorder (MDD) were varied and not fully understood. In this review, we describe the underlying molecular mechanisms between m6A and depression from several aspects including inflammation, stress, neuroplasticity including neurogenesis, and brain structure, which contain the interactions of m6A with cytokines, the HPA axis, BDNF, and other biological molecules or mechanisms in detail. Finally, we summarized the perspectives for the improved understanding of the pathogenesis of depression and the development of more effective treatment approaches for this disorder.

Chronic unpredictable mild stress-induced anxiety is linked to inflammatory responses and disruptions in tryptophan metabolism in male C57BL/6N mice

Chronic stress can affect brain function through various mechanisms, leading to the development of anxiety disorders. The chronic unpredictable mild stress (CUMS) is a classic model of chronic stress. This study evaluated the effects of different durations of CUMS on anxiety-like behavior, inflammation, and tryptophan metabolism in C57BL/6N mice. The results of behavioral assessments showed that after 3 and 4 weeks of CUMS exposure, the mice exhibited significant decreases in open arms ratio and time ratio in the elevated plus maze (EPM), prolonged latency in the novelty-suppressed feeding test (NSFT), and reduced transitions in the light/dark box (LDB), all indicative of anxiety-like behavior. The inflammatory factors expressions were quantified using qPCR, showing that pro-inflammatory and anti-inflammatory markers began to rise following 1-2 weeks of CUMS exposure. After 3 weeks of stress, TNF-α significantly increased, TGF-β levels started to decrease, and by 4 weeks of CUMS, Arg-1 expression also declined. In terms of tryptophan metabolism, 5-HT content in the hippocampus of the mice began to decrease after 3 weeks of CUMS, while the levels of neuroprotective kynurenic acid (KYNA) continued to rise. Concurrently, neurotoxic substances, including 3-hydroxykynurenine (3-HK) and quinolinic acid (QA), accumulated; after 4 weeks of CUMS, the KYNA content also started to decline. In conclusion, CUMS exposure for 3-4 weeks in male C57BL/6 N mice induces anxiety-like behavior alongside the occurrence of inflammatory responses and disturbances in tryptophan metabolism. These findings highlight the complex interplay between stress, inflammation, and metabolic pathways in the etiology of anxiety-related behaviors.

Human alpha-herpesvirus 1 (HSV-1) viral replication and reactivation from latency are expedited by the glucocorticoid receptor

Acute human alpha-herpesvirus 1 (HSV-1) infection leads to infection of neurons within trigeminal ganglia (TG), brainstem, and other regions of the central nervous system. Lytic cycle viral gene expression is subsequently silenced, a subset of neurons survive infection, and life-long latency is established. In contrast to lytic infection, the latency-associated transcript (LAT) is the only viral gene product abundantly expressed in latently infected neurons. Stress (acute or chronic), UV light, or heat stress increases the incidence of reactivation from latency in humans and mouse models of infection. Ironically, these divergent reactivation stimuli activate the glucocorticoid receptor (GR). Recent studies revealed GR and Krüppel-like factors (KLF), KLF4 or KLF15 for example, cooperatively transactivate the infected cell protein 0 (ICP0) promoter and cis-regulatory motifs that activate ICP4 and ICP27 promoter activity. GR and KLF4 are "pioneer transcription factors" that specifically bind DNA even when it exists as heterochromatin; consequently, chromatin is remodeled, and transcription is activated. Conversely, a VP16 cis-regulatory motif is transactivated by GR and Slug but not KLF family members. Female mice that express a GR containing a serine → alanine mutation at position 229 (GRS229A) shed significantly lower HSV-1 levels compared with age-matched male GRS229A mice or wild-type parental C57BL/6 mice during reactivation from latency. These observations imply GR and stress-induced cellular transcription factors play an important role during reactivation from latency by activating key viral promoters. GR activation may also enhance virus spread by impairing immune and inflammatory responses.

GDF15 links adipose tissue lipolysis with anxiety

Psychological stress changes both behaviour and metabolism to protect organisms. Adrenaline is an important driver of this response. Anxiety correlates with circulating free fatty acid levels and can be alleviated by a peripherally restricted β-blocker, suggesting a peripheral signal linking metabolism with behaviour. Here we show that adrenaline, the β3 agonist CL316,243 and acute restraint stress induce growth differentiation factor 15 (GDF15) secretion in white adipose tissue of mice. Genetic inhibition of adipose triglyceride lipase or genetic deletion of β-adrenergic receptors blocks β-adrenergic-induced increases in GDF15. Increases in circulating GDF15 require lipolysis-induced free fatty acid stimulation of M2-like macrophages within white adipose tissue. Anxiety-like behaviour elicited by adrenaline or restraint stress is eliminated in mice lacking the GDF15 receptor GFRAL. These data provide molecular insights into the mechanisms linking metabolism and behaviour and suggest that inhibition of GDF15-GFRAL signalling might reduce acute anxiety.

A New Heartbeat-Respiration Coupling Metric for Relaxation/Stress Monitoring

OBJECTIVE

Identification and continuous monitoring of relaxation/stress level through easily measurable physiological signals has become an urgent need. Relaxation/stress is mainly mediated by autonomic nervous system (ANS) which can hardly be noninvasively-measured, but can be reflected in heartbeat and respiration because the human body is a strongly coupling system. However, existing metrics based on heart rate and respiration present low accuracy for relaxation assessment. Our main objective is to propose a reliable metric for relaxation/stress monitoring.

METHODS

By improving the quantification of Respiratory Sinus Arrhythmia (RSA) and introducing the phase difference between heart rate and respiration, we construct a new metric called Heart-Breath Coherence (HBC) based on heart rate and respiration collected synchronously. Firstly, its practical performance is examined by the multi-scenario experiment with 34 volunteers, which contains four scenarios: smelling odors, listening to sounds, emotional evocations, and watching videos. Then, the synthetic data are employed to test the precision of RSA quantification by HBC.

RESULTS

Comparing with 26 existing metrics, HBC shows the highest accuracy 91% (p-value 0.01 and effect size 0.8) in the multi-scenario experiment. The introduction of magnitude of phase difference is crucial for the success. Synthetic studies show that HBC improves the RSA quantification with the minimum error comparing to other metrics.

CONCLUSION

HBC is a reliable metric for relaxation/stress monitoring and RSA quantification.

SIGNIFICANCE

HBC can provide the real-time monitoring of relaxation/stress level and reflect the ANS balance, which is meaningful for healthcare and may be used for psychology and clinical practice.

Androgen receptors in corticotropin-releasing hormone neurons mediate the sexual dimorphism in restraint-induced thymic atrophy

Sexual dimorphism in immune responses is well documented, but the underlying mechanisms remain incompletely understood. Here, we identified a subset of corticotropin-releasing hormone (CRH) neurons that express androgen receptors (ARs) as key mediators of sex differences in restraint-induced immunosuppression. Mechanistically, androgens directly activate AR-positive CRH neurons, enhancing the hypothalamic-pituitary-adrenal axis activation. This results in elevated corticosterone levels in response to restraint stress, leading to increased immune cell apoptosis and immune organ atrophy in male mice. Conditional knockout of ARs in CRH neurons eliminated this sexual dimorphism, highlighting ARs in CRH neurons as pivotal regulators of sex-specific immune responses to stress.

Mourning for Silence: Bereavement and Tinnitus-A Perspective

Tinnitus is defined as the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes tinnitus disorder when the phantom sound is associated with suffering and/or disability. There is only limited knowledge about the time course of tinnitus disorder. Bereavement science has identified four different trajectories: resilience, recovery, chronic, and delayed. The question arises whether these four trajectories exist in tinnitus as well if one considers tinnitus as the loss of silence (at will). To verify whether these four trajectories exist, short-term tinnitus progression was analyzed retrospectively using an Ecological Momentary Assessment (EMA) approach, extracting the data from patients who started using the TrackYourTinnitus (TYT) app (version 1, Ulm University, 2013) from the start of their tinnitus perception. Four patients were identified retrospectively via the TYT app with acute tinnitus, and the bereavement trajectories were reconstructed based on EMA. In conclusion, this perspective suggests that the four known bereavement trajectories may exist in tinnitus, and prospective evaluations of larger samples are warranted to confirm or disprove this analogy between bereavement and tinnitus, in which tinnitus is conceived as the loss of (controllable) silence.

The stress-immune system axis: Exploring the interplay between stress and immunity

The chapter talks about how our body and mind respond to stress and how it affects our immune system. Stress reactions, especially the fight-or-flight reaction, are helpful at first but can be harmful if they last too long. Long-term stress, caused by hormones like cortisol and adrenaline, weakens the immune system and makes people more likely to get sick. Important brain chemicals like serotonin and norepinephrine help control how our immune system works. Also, the connection between our gut and brain is an important way that mental health affects how our immune system functions. Getting older and experiencing stress early in life can affect how our immune system works. Inflammation caused by stress is connected to health issues like heart disease, depression, and autoimmune diseases. There are ways to manage stress, like being mindful and having support from friends, are important for keeping your immune system healthy and lessening harm caused by stress.

Stress and telomere length in leukocytes: Investigating the role of GABRA6 gene polymorphism and cortisol

Telomere length (TL) is considered a biomarker of aging, and short TL in leukocytes is related to age and stress-related health problems. Cumulative lifetime stress exposure has also been associated with shorter TL and age-related health problems, but the mechanisms are not well understood. We tested in 108 individuals whether shorter TL in leukocytes is observed in individuals with the GABRA6 TT genotype, which has been associated with dysregulation of hypothalamic-pituitary-adrenal axis activity (the main biological stress system) compared to the CC genotype. We also investigated if individuals carrying the TT genotype show higher stress-induced and diurnal cortisol secretion and if cortisol explains the interindividual variability in TL. The analysis pipeline of this study was pre-registered, and the results showed that GABRA6 TT carriers had shorter TL in CD8+CD28+ cells (Bonferroni corrected). In contrast to previous studies, no differences between groups in cortisol secretion were observed, and TL and cortisol did not show significant associations. This study shows, for the first time, shorter TL in CD8+CD28+ cells in TT carriers for GABRA6 compared to CC carriers, suggesting accelerated cellular aging. Although this difference could be linked to an increased susceptibility to stress in the TT carriers, this could not be attributed to the direct influence of cortisol, suggesting the involvement of other mechanisms.

[Patient-reported outcome measures-use in diagnosing depression, anxiety, and stress]

Patient-reported outcome measures (PROMs) is an umbrella term for various self-report instruments used to assess subjective health-related impressions and treatment success from the patient's perspective. In psychosomatic medicine, PROMs are often used to record subjective symptoms, psychosocial distress, and changes in health status, particularly in patients with comorbid (affective) disorders and frequent contact with physicians, but also in preventive health care and to monitor the effectiveness of treatment. In otolaryngology (ENT), self-report questionnaires (PROMs) are used, among other things, to assess the impact of hearing, speech, swallowing, and breathing disorders on patients' quality of life. Such scientifically validated tools make it possible to better understand the needs and priorities of patients and to integrate them into clinician-patient communication and treatment to promote individual, patient-centered care. Three dimensions for the assessment of subjective health-related experiences (depression, anxiety, stress) with corresponding instruments for the German-speaking area for use in clinical and research settings are presented in more detail, specifically for otolaryngology.

Lateral Ventricular Enlargement and Asymmetry and Myelin Content Imbalance in Individuals With Bipolar and Depressive Disorders: Clinical and Research Implications

BACKGROUND

The link between ventricular enlargement and asymmetry with other indices of brain structure remains underexplored in individuals with bipolar (BD) and depressive (DD) disorders. Our study compared the lateral ventricular size, ventricular asymmetry, and cortical myelin content in individuals with BD versus those with DD versus healthy controls (HC).

METHODS

We obtained T1w and T2w images from 149 individuals (age = 27.7 (SD = 6.1) years, 78% female, BD = 38, DD = 57, HC = 54) using Magnetic Resonance Imaging (MRI). The BD group consisted of individuals with BD Type I (n = 11) and BD Type II (n = 27), while the DD group consisted of individuals with major depressive disorder (MDD, n = 38) and persistent depressive disorder (PDD, n = 19) Cortical myelin content was calculated using the T1w/T2w ratio. Elastic net regularized regression identified brain regions whose myelin content was associated with ventricular size and asymmetry. A post hoc linear regression examined how participants' diagnosis, illness duration, and current level of depression moderated the relationship between the size and asymmetry of the lateral ventricles and levels of cortical myelin in the selected brain regions.

RESULTS

Individuals with BD and DD had larger lateral ventricles than HC. Larger ventricles and lower asymmetry were observed in individuals with BD who had longer lifetime illness duration and more severe current depressive symptoms. A greater left asymmetry was observed in participants with DD than in those with BD (p < 0.01). Elastic net revealed that both ventricular enlargement and asymmetry were associated with altered myelin content in cingulate, frontal, and sensorimotor cortices. In BD, but not in other groups, ventricular enlargement was related to altered myelin content in the right insular regions.

CONCLUSIONS

Lateral ventricular enlargement and asymmetry are linked to myelin content imbalance, thus potentially leading to emotional and cognitive dysfunction in mood disorders.

Stress-mediating inflammatory cytokine profiling reveals unique patterns in malaria and typhoid fever patients

Malaria and typhoid fever pose significant health risks, leading to severe morbidity and mortality when inadequately treated. Understanding the role of stress-related inflammatory cytokines is crucial, as they mediate immune responses that affect pathogen clearance and recovery. This study investigated the cytokine profiles in patients with malaria and/or typhoid fever attending the Obala District Hospital in Yaoundé, Cameroon. We conducted a cross-sectional observational study measuring cortisol and inflammatory cytokines in blood samples from 55 infected patients and a control group of 15 healthy individuals using ELISA kits. We also evaluated psychological stress over the past 30 days using a 10-item Perceived Stress Scale (PSS) questionnaire to explore the link between stress and immune response. Psychological stress levels were notably higher in the typhoid fever group (18.20 ± 5.5) compared to the other groups, although these differences were statistically insignificant. Cortisol levels were significantly elevated (p < 0.001) across all patient groups compared to controls, with the typho-malaria group demonstrating a 2.5-fold increase. Notably, cytokine levels were elevated in patients with malaria and typhoid comorbidity, particularly IL-1β, IL-2, TNF-α, and IFN-γ. While IL-6 concentrations were significantly higher in malaria and typho-malaria co-infected patients, IL-10 levels were reduced in the typho-malaria group but remained elevated compared to controls. The TNF-α/IL-10 ratio was significantly higher in the co-infected group, suggesting a heightened inflammatory response. Additionally, there was a positive correlation between perceived stress scores and IL-2 (r = 0.365, p = 0.002), IFN-γ (r = 0.248, p = 0.03), and IL-6 (r = 0.412, p = 0.0001) in the typho-malaria group. Beyond IL-6, no significant correlations were observed between stress indices and the anti-inflammatory cytokines IL-4 (r = 0.204, p = 0.09) and IL-10 (r = 0.153, p = 0.20) among co-infected individuals. These results suggest that stress response may play a crucial role in shaping the inflammatory landscape during malaria and typhoid fever. Exposure to severe stressors may disrupt immune response and contribute to negative health outcomes. Understanding the immunopathogenesis of these diseases could potentially pave the way for the development of novel therapeutic strategies targeting the stress-cytokine axis.

Chronic unpredictable mild stress induces anxiety-like behavior in female C57BL/6N mice, accompanied by alterations in inflammation and the kynurenine pathway of tryptophan metabolism

Chronic stress can impact brain function through various mechanisms, contributing to the development of anxiety disorders. Chronic unpredictable mild stress (CUMS) is a well-established model for studying the effects of chronic stress. This study assessed the impacts of different durations of CUMS on anxiety-like behavior, inflammation, and tryptophan metabolism in female C57BL/6N mice. The results revealed significant behavioral changes after 2-4 weeks of CUMS. Specifically, the open arms ratio and open arms time ratio in the elevated plus maze (EPM) decreased, the latency to feed in the novelty-suppressed feeding test (NSFT) was prolonged, and the number of transitions in the light/dark box (LDB) was decreased. After 1 week of CUMS, the levels of some pro-inflammatory cytokines (such as IL-1β and iNOS) and anti-inflammatory cytokines (including IL-10) began to rise. After 2 weeks of CUMS, most pro-inflammatory cytokines (IL-1β, IL-6, CD86, iNOS) and the anti-inflammatory cytokines TGF-β and CD11b showed an increase, while some anti-inflammatory cytokines (Arg-1, IL-10) began to decrease. After 3 weeks of stress, the pro-inflammatory cytokine TNF-α also significantly increased, while the anti-inflammatory cytokine TGF-β began to decline. By 4 weeks of CUMS, the anti-inflammatory cytokine CD11b also started to decrease. Regarding tryptophan metabolism, after 3-4 weeks of CUMS, serotonin (5-HT) levels in the hippocampus of the mice began to decrease. Additionally, the kynurenine pathway in tryptophan metabolism shifted more towards the KYN-QA branch, resulting in the reduction in the neuroprotective substance kynurenic acid (KYNA), while neurotoxic substances such as 3-hydroxykynurenine (3-HK) and quinolinic acid (QA) accumulated. In summary, female C57BL/6N mice exhibit anxiety-like behavior after 2 weeks of CUMS, accompanied by inflammatory responses. After 3-4 weeks of CUMS, anxiety-like behavior persists, with exacerbated inflammatory responses and disturbances in tryptophan metabolism.

Effect of housing density on cellular and humoral immunity, hematology in striped hamsters

Population density is one of the most important factors influencing immune function. Social stress induced by higher density may account for the immunosuppression according to the endocrine hypothesis. To test this hypothesis, male striped hamsters (Cricetulus barabensis) were classified into the One/Cage (n = 9), Two/Cage (n = 6), and Three/Cage (n = 9) groups, and the treatment lasted for 45 days. The titers of immunoglobin (Ig)G15 and IgM 10 were lower in the Two/Cage group compared to the One/Cage group, indicating that higher housing density suppressed humoral immunity. However, the masses of thymus and spleen, phytohaemagglutinin (PHA) responses at 6 h, 12 h, 24 h, 48 h, and 72 h after PHA injection, the titers of IgG 5, IgG10, IgM5, and IgM15 were all not affected by housing density. Blood glucose level was higher in the One/Cage group than the other two groups, leptin titers did not differ among the three groups, whereas corticosterone concentration was higher in the Two/Cage and Three/Cage groups than in the One/Cage group. Moreover, negative correlation was observed between corticosterone concentration and the titers of IgG5, IgG10, IgG15, and IgM10. These results suggested that humoral immunity was reduced by higher stress levels induced by higher housing density, which supported the endocrine hypothesis. White blood cell (WBC) count was higher in the Two/Cage group than in the One/Cage group, and intermediate granulocytes (MID) were higher in the Two/Cage group than in the One/Cage and Three/Cage groups, indicating the fight and injury might have arisen in the higher housing density.

A scoping review on early childhood caries and inequalities using the Sustainable Development Goal 10 framework

BACKGROUND

Social inequalities contribute to health disparities. This study aimed to map evidence on early childhood caries (ECC) related to the United Nations' Sustainable Development Goal 10 (SDG 10).

METHODS

A scoping review was conducted in May 2024 following the PRISMA-ScR guidelines. A literature search was performed in PubMed, Web of Science, and CINAHL for studies published in English and addressing population level social inequalities. Studies measuring individual level of social inequalities were excluded as they were covered by other SDGs. However, studies incorporating individual measures as additional measures of population level social inequality were included. Retrieved papers were summarized, inductively analysed and a conceptual framework linking SDG 10 was developed.

RESULTS

Of 452 studies retrieved, 42 met the inclusion criteria. Studies measured inequality among groups (deprivation, family income, indigenous communities, ethnicity, minority status) [14 studies], institutions (type of school, nursery or school facility, school poverty index, public primary health care units) [five studies], and inequality in communities (neighbourhood socio-economic status, Human Development Index, employment rate, income inequality, sanitary sewer and water supply, residents/household ratio, urban vs rural vs remote rural, accessibility index, location index, the slope index of inequality) [24 studies]. These levels of social inequalities were linked to higher prevalence of ECC; social and economic policies contributed to widening inequalities in ECC severity; and although effective interventions targeted at at-risk populations could reduce dental health disparities, study interventions differed by deprivation status. Six studies (14.3%) addressed SDG 10.1, 33 (78.6%) addressed SDG 10.2, 11 (26.2%) addressed SDG 10.3, and three (7.1%) addressed SDG 10.4. Fourteen studies (33.3%) addressed a combination of SDGs. The conceptual framework highlights the role of structural inequalities stemming from the cumulative impact of institutional decisions and systemic inequalities.

CONCLUSION

This scoping review underscores the profound influence of social inequality on ECC through interactions between multi-level factors. Further research is needed to explore the links between ECC and other SDG 10 targets, especially in low- and lower-middle-income countries.

Caregiver burden and risk of epithelial ovarian cancer in the Nurses' Health Studies

Psychosocial stress may increase ovarian cancer risk and accelerate disease progression. We examined the association between caregiver burden, a common stressor, and risk of epithelial ovarian cancer. We prospectively followed 67 724 women in the Nurses' Health Study (1992-2012) and 70 720 women in the Nurses' Health Study II (2001-2009) who answered questions on informal caregiving (ie, caregiving outside of work). Women who reported no informal caregiving were considered noncaregivers, while, among women who provided care outside of work, caregiver burden was categorized by time spent caregiving and perceived stress from caregiving. For the 34% of women who provided informal care for ≥15 hours per week, 42% described caregiving as moderately to extremely stressful. Pooled multivariate analyses indicated no difference in ovarian cancer risk for women providing ≥15 hours of care per week compared to noncaregivers (hazard ratio [HR] = 0.96; 95% confidence interval [CI], 0.79-1.18), and no association was evident for women who reported moderate or extreme stress from caregiving compared to noncaregivers (HR = 0.96; 95% CI, 0.75-1.22). Together with prior work evaluating job strain and ovarian cancer risk, our findings suggest that, when evaluating a stressor's role in cancer risk, it is critical to consider how the stressor contributes to the overall experience of distress. This article is part of a Special Collection on Gynecological Cancer.

Current Strategies and Future Directions of Wearable Biosensors for Measuring Stress Biochemical Markers for Neuropsychiatric Applications

Most wearable biosensors aimed at capturing psychological state target stress biomarkers in the form of physical symptoms that can correlate with dysfunction in the central nervous system (CNS). However, such markers lack the specificity needed for diagnostic or preventative applications. Wearable biochemical sensors (WBSs) have the potential to fill this gap, however, the technology is still in its infancy. Most WBSs proposed thus far target cortisol. Although cortisol detection is demonstrated as a viable method for approximating the extent and severity of psychological stress, the hormone also lacks specificity. Multiplex WBSs that simultaneously target cortisol alongside other viable stress-related biochemical markers (SBMs) can prove to be indispensable for understanding how psychological stress contributes to the pathophysiology of neuropsychiatric illnesses (NPIs) and, thus, lead to the discovery of new biomarkers and more objective clinical tools. However, none target more than one SBM implicated in NPIs. Till this review, cortisol's connection to dysfunctions in the CNS, to other SBMs, and their implication in various NPIs has not been discussed in the context of developing WBS technology. As such, this review is meant to inform the biosensing and neuropsychiatric communities of viable future directions and possible challenges for WBS technology for neuropsychiatric applications.

Habituation of the biological response to repeated psychosocial stress: a systematic review and meta-analysis

Recurrent psychosocial stress poses a significant health challenge, prompting research into mechanisms of successful adaptation. Physiological habituation, defined as decreased reactivity to repeated stressors, is pivotal in protecting the organism from allostatic load. Here, we systematically review and meta-analyze data from studies investigating the capacity of central stress systems to habituate when repeatedly exposed to a standardized psychosocial stressor, the Trier Social Stress Test (k = 47). For a comprehensive overview of biological stress systems, we examine multiple markers of the hypothalamic-pituitary-adrenal (HPA) axis, the autonomic nervous system (ANS), and the immune system. Our findings indicate that habituation patterns vary substantially between different stress systems. While most studies provide robust evidence for rapid and substantial HPA-axis habituation, ANS and immune marker responses to repeated stress are less uniform. We further integrate existing knowledge on personal and environmental influences contributing to individual differences in habituation capacity. Additionally, we discuss the implications of stress habituation patterns for health outcomes and the design of longitudinal stress studies and highlight potential avenues for future research.

Testing the Population-Level Effects of Stress-Induced Susceptibility in the Ranavirus-Wood Frog System

Chronic exposure to physical, chemical, and biotic stressors can make animals more susceptible to infections. Such stress-induced susceptibility is widely expected to make disease-and epidemics-more likely and more severe. However, whether the impacts of stressors on individuals scale up to population-level outcomes is uncertain, both theoretically and empirically. We initiated ranavirus epidemics in replicate mesocosm populations of larval wood frogs (Lithobates sylvaticus) exposed to conditions known to impact their individual susceptibility to ranavirus infections: low and high salinity crossed factorially with ambient or elevated temperatures. Contrary to expectations, epidemics were no more likely or more severe in stressful conditions, although increased temperatures did speed their progression. We discuss several potential reasons why the effects of stressors did not scale up to epidemics, but our results suggest caution in assuming the individual-level effects of even well-studied stressors necessarily scale simply to population-level outcomes.

Housing insecurity pathways to physiological and epigenetic manifestations of health among aging adults: a conceptual model

Introduction

Housing insecurity is a social determinant of health, as evidenced by its associations with mental, physical, and biological outcomes. The scientific understanding of the mechanisms by which housing insecurity is associated with health is still limited. This review adapts existing stress process models to propose a conceptual model illustrating potential pathways linking the specific stressor of housing insecurity to physiological and epigenetic manifestations of stress among aging adults.

Methods

This narrative review examines literature across multiple fields, including public health, psychology, and sociology. The literature selected for this review was identified through scientific databases including Web of Science, PubMed, JSTOR, and Google Scholar; primarily peer-reviewed empirical studies, literature reviews, and research reports published in English between 1981 and 2024; and principally based in the United States context. A synthesis of this literature is presented in a proposed conceptual model.

Results

The literature supports the existence of two main predictors of housing insecurity: sociodemographic characteristics and the historical/current context. The main mediating pathways between housing insecurity and manifestations of stress include health behaviors, psychosocial resources, and structural resources. Moderating factors affecting the associations between housing insecurity and manifestations of stress include government assistance, chronic discrimination/unfair treatment, and individual differences. These interdependent mediating and moderating mechanisms affect stressor reactivity, a proximal manifestation of stress, which contributes to the physiological and epigenetic distal manifestations of stress in aging adults.

Discussion and implications

The prevalence of housing insecurity among aging adults is growing in the United States, with significant implications for public health and health disparities, given the growing percentage of aging adults in the population. Further empirical testing of the mediating and moderating mechanisms proposed in the conceptual model will elucidate how housing insecurity is connected to health and provide insight into preventive strategies to ameliorate the adverse effects of housing insecurity on biological health among aging adults.

Degree of housing damage caused by the Great East Japan Earthquake and all-cause mortality in the community-based cohort study of the Tohoku Medical Megabank Project

BACKGROUND

Natural disasters may have negative health effects on survivors. However, long-term observations on this are lacking. Therefore, this study investigated the association between the degree of housing damage caused by the Great East Japan Earthquake (GEJE) and all-cause mortality using the data from the cohort study conducted by the Tohoku Medical Megabank (TMM) Project in disaster-stricken areas.

METHODS

The community-based cohort study of the TMM Project which conducted a baseline survey from May 2013 to March 2016 collected data using questionnaires and blood and urine tests. The present large-scale prospective cohort study was a follow-up survey in which the degree of house damage and all-cause mortality were analysed using Cox proportional hazards regression, adjusting for sex, age and other potentially confounding variables. The degree of house damage was categorised into 'did not live in the disaster area', 'no damage', 'small-scale damage' and 'large-scale damage'. Among the 58 320 participants, 1763 deaths were confirmed during the follow-up which averaged 6.5 years.

RESULTS

The multivariate analysis showed a hazard ratio (95% CI) of 0.96 (0.82 to 1.13) for those who did not live in the disaster area, 0.98 (0.87 to 1.10) for small-scale damage and 0.98 (0.85 to 1.14) for large-scale damage, compared with no damage, but no significant association with all-cause mortality was observed.

CONCLUSION

The results of this large-scale prospective cohort study of GEJE survivors showed no significant relationship between the degree of house damage and all-cause mortality. Further long-term follow-up studies are needed to examine the long-term health effects of natural disasters on survivors.

Regulation of Stress-Induced Immunosuppression in the Context of Neuroendocrine, Cytokine, and Cellular Processes

Understanding the regulatory mechanisms of stress-induced immunosuppression and developing reliable diagnostic methods are important tasks in clinical medicine. This will allow for the development of effective strategies for the prevention and treatment of conditions associated with immune system dysfunction induced by chronic stress. The purpose of this review is to conduct a comprehensive analysis and synthesis of existing data on the regulatory mechanisms of stress-induced immunosuppression. The review is aimed at identifying key neuroendocrine, cytokine, and cellular processes underlying the suppression of the immune response under stress. This study involved a search of scientific literature covering the neuroendocrine, cellular, and molecular mechanisms of stress-induced immunosuppression regulation, as well as modern methods for its diagnosis. Major international bibliographic databases covering publications in biomedicine, psychophysiology, and immunology were selected for the search. The results of the analysis identified key mechanisms regulating stress-induced immunosuppression. The reviewed publications provided detailed descriptions of the neuroendocrine and cytokine processes underlying immune response suppression under stress. A significant portion of the data confirms that the activation of the hypothalamic-pituitary-adrenal (HPA) axis and subsequent elevation of cortisol levels exert substantial immunosuppressive effects on immune cells, particularly macrophages and lymphocytes, leading to the suppression of innate and adaptive immune responses. The data also highlight the crucial role of cortisol and catecholamines (adrenaline and noradrenaline) in initiating immunosuppressive mechanisms under chronic stress.

Elevated IL-22 as a result of stress-induced gut leakage suppresses septal neuron activation to ameliorate anxiety-like behavior

Psychological stress and its sequelae pose a major challenge to public health. Immune activation is conventionally thought to aggravate stress-related mental diseases such as anxiety disorders and depression. Here, we sought to identify potentially beneficial consequences of immune activation in response to stress. We showed that stress led to increased interleukin (IL)-22 production in the intestine as a result of stress-induced gut leakage. IL-22 was both necessary and sufficient to attenuate stress-induced anxiety behaviors in mice. More specifically, IL-22 gained access to the septal area of the brain and directly suppressed neuron activation. Furthermore, human patients with clinical depression displayed reduced IL-22 levels, and exogenous IL-22 treatment ameliorated depressive-like behavior elicited by chronic stress in mice. Our study thus identifies a gut-brain axis in response to stress, whereby IL-22 reduces neuronal activation and concomitant anxiety behavior, suggesting that early immune activation can provide protection against psychological stress.

Psychometric Properties of the Persian Version of Sickness Impact Profile-30 (SIP-30) in Community-Dwelling Older Adults

Purpose: Accurate measurement tools are essential for evaluating the health-related quality of life in older adults. We aimed to translate and evaluate the psychometric properties of the Sickness Impact Profile-30 (SIP-30) in community-dwelling older adults. Materials and Methods: One hundred and fifty older adults participated in this study. To evaluate construct validity, its correlation with General Health Questionnaire-28, Geriatric Depression Scale-15, Hospital Anxiety and Depression Scale, Modified Health Assessment Questionnaire, Numeric Pain Rating Scale, and Fullerton Advanced Balance Scale was assessed. Reliability features were also investigated. Results: The results of construct validity analysis demonstrated a moderate to high (r = 0.61-0.84) correlation between the total score of SIP-30 and GHQ-28, GDS-15, HADS, MHAQ, and NPRS. There was a moderate inverse (r = -0.67) correlation between the total score of the SIP-30 and the FAB Scale. Test-retest reliability (ICC > 0.83) and internal consistency (α = 0.94) of the Persian SIP-30 were high. Conclusions: The results indicated that the Persian SIP-30 is a reliable and valid measure to assess health-related quality of life in community-dwelling older adults.

Primary and secondary allostatic processes in the context of high-stress work: A multigroup moderation from the English longitudinal study of ageing

Evidence suggests that chronic cortisol excess may precede the development of an allostatic load, and that this association may be influenced by the level of work stress. This study aims to investigate the associations between hair cortisol concentration and the development of systemic allostatic load cross-sectionally and at a lag of four years, stratified by level of effort-reward imbalance. The sample consisted of respondents from the English Longitudinal Study of Ageing (ELSA) who were in employment with hair cortisol measurements at baseline (wave 6), and allostatic load markers at baseline and follow-up (wave 8; n=411; 64 % female). Hair cortisol was used as a measure of total cortisol expression over the preceding two months. Allostatic load was modelled as a count-based index using nine markers; three per system, across the immune, metabolic and cardiovascular systems. This model was then grouped by a median-cut effort reward-imbalance scale (0.83) and regression pathways were compared between groups using a series of Chi-Squared tests of difference. Results provide evidence that higher hair cortisol concentrations predict an increase in immune and cardiovascular allostatic load cross-sectionally, and a metabolic allostatic load at a lag of four years. These pathways were found in the high effort-reward imbalance group, but not in the low effort-reward imbalance group. There were also significant differences found between groups for hair cortisol concentration as a predictor of concurrent immune and cardiovascular allostatic load Findings may indicate a novel temporality to the accumulation of an allostatic load, and that the "tipping point" between allostasis and allostatic load may lie within the ability of the HPA axis to regulate the cardiovascular system concurrently, with longitudinal consequences for metabolic syndrome indicators.

Exploring the Perceptions of Construction Workers and Senior Management Towards Mental Wellness Interventions Using Q-Methodology

The construction industry faces a significant crisis with rising suicide rates and mental health issues among workers. Addressing these challenges requires both systemic changes in work practices and improved access to mental wellness resources. However, there is limited research on the perceptions of both workers and senior management towards proposed solutions to reducing psychological distress experienced in occupational settings. Understanding these perceptions is crucial to determining the needs and acceptability of different wellness interventions. Thus, this study aimed to uncover preferences for validated wellness interventions in occupational settings by exploring the attitudes of 12 senior managers and 15 frontline workers using Q-Methodology. Findings revealed that frontline workers favored personalized wellness interventions tailored to their unique situations. Additionally, notable differences were identified between frontline workers and senior managers in their views on policies and practices aimed at reducing workload pressures and enhancing accountability and communication. The data also showed that current contracting and work practices potentially hinder the implementation of interventions perceived to be most beneficial by workers and senior managers. These results provide valuable insights for future research and offer guidance to organizations on designing, implementing, and communicating effective wellness interventions.

Epigenome-wide mediation analysis of the relationship between psychosocial stress and cardiometabolic risk factors in the Health and Retirement Study (HRS)

BACKGROUND

Exposure to psychosocial stress is linked to a variety of negative health outcomes, including cardiovascular disease and its cardiometabolic risk factors. DNA methylation has been associated with both psychosocial stress and cardiometabolic disease; however, little is known about the mediating role of DNA methylation on the association between stress and cardiometabolic risk. Thus, using the high-dimensional mediation testing method, we conducted an epigenome-wide mediation analysis of the relationship between psychosocial stress and ten cardiometabolic risk factors in a multi-racial/ethnic population of older adults (n = 2668) from the Health and Retirement Study (mean age = 70.4 years).

RESULTS

A total of 50, 46, 7, and 12 CpG sites across the epigenome mediated the total effects of stress on body mass index, waist circumference, high-density lipoprotein cholesterol, and C-reactive protein, respectively. When reducing the dimensionality of the CpG mediators to their top 10 uncorrelated principal components (PC), the cumulative effect of the PCs explained between 35.8 and 46.3% of these associations.

CONCLUSIONS

A subset of the mediating CpG sites were associated with the expression of genes enriched in pathways related to cytokine binding and receptor activity, as well as neuron development. Findings from this study help to elucidate the underlying mechanisms through which DNA methylation partially mediates the relationship between psychosocial stress and cardiometabolic risk factors.

The Mediating Effects of Chronic Diseases in the Relationship Between Adverse Childhood Experiences and Trajectories of Depressive Symptoms in Later Life: A Nationwide Longitudinal Study

Background: Numerous studies have established a link between adverse childhood experiences (ACEs) and the development of depression in later life. However, the interactive relationships between ACEs, depression, and chronic diseases are still not well understood. In this study, the aim was to investigate the impact of ACEs on depressive trajectories among middle-aged and elderly individuals in China, as well as to examine the mediating roles of chronic diseases in this association. Methods: Data were drawn from 6921 participants aged 45 and older, using the China Health and Retirement Longitudinal Study (CHARLS) data from 2011, 2013, 2015, and 2018, combined with the 2014 life history survey. Depressive symptom scores were assessed using the widely recognized CES-D-10 scale. The trajectories of depressive symptoms were identified via group-based trajectory modeling (GBTM). The association between ACEs and depressive trajectories was analyzed using multinomial logistic regression, and the KHB method was employed to test the mediating effects of different chronic diseases. Results: The age of the 6921 participants was 57.2 ± 8.0 years, with females comprising 53.9% and males 46.1%. We found that approximately 70% of Chinese middle-aged and older adults had experienced at least one ACE, and 4.8% had experienced four or more ACEs. The following four distinct trajectories of depressive symptoms were identified: continuing-low (N = 1897, 27.4%), continuing-low-to-middle (N = 2937, 42.4%), continuing-middle-to-high (N = 1649, 23.8%), and continuing-high (N = 438, 6.3%). Compared to individuals without ACEs, those with four or more ACEs had a significantly higher likelihood of following the continuing-low-to-middle trajectory (OR = 2.407, 95%CI: 1.633-3.550), the continuing-middle-to-high trajectory (OR = 7.458, 95%CI: 4.999-11.127), and the continuing-high trajectory (OR = 20.219, 95%CI: 12.115-33.744), rather than the continuing-low trajectory. Exposure to a greater number of ACEs was associated with an increased risk of following an adverse trajectory of depressive symptoms. Multiple chronic diseases significantly mediated the relationship between ACEs and depressive trajectories, with arthritis or rheumatism exerting the largest mediating effect, followed by digestive and respiratory diseases. Conclusions: These findings indicated that ACEs were associated with a higher risk of worse depressive symptom trajectories, with different chronic diseases mediating this relationship. Therefore, developing public measures to prevent ACEs can reduce the risk of chronic diseases and depression in middle-aged and elderly people. Additionally, strengthening the prevention and management of chronic diseases in individuals exposed to ACEs may further reduce their subsequent risk of depression.

How patients experience discussing couple relationship problems with GPs: an interview study

BACKGROUND

Couple relationship satisfaction is related to good physical health, good mental health, and longevity. Many patients have discussed or wish to discuss their couple relationship with their GP and look for personalised care and support when discussing topics they perceive as sensitive.

AIM

To explore patient experiences of discussing couple relationship problems in GP consultations.

DESIGN & SETTING

Qualitative study employing semi-structured interviews with patients from general practice in Norway.

METHOD

Individual interviews with 18 patients who had discussed their couple relationship with their GP. Participants were recruited through both social media and traditional media, and all interviews were digitally recorded. The purposive sample comprised 13 women and five men, representing diverse age groups, backgrounds, and relationship problems. All participants identified as heterosexual. We analysed interview data thematically using systematic text condensation.

RESULTS

Three main themes emerged: 1) GPs in a facilitating role, not on an assembly line; 2) navigating the 'elephant in the room'; and 3) GPs as biomedically competent life witnesses. GP continuity was vital in fostering the trust required to discuss sensitive topics, such as relationship issues. Participants valued a biopsychosocial approach that incorporated knowledge of close relationships into medical consultations. They appreciated both GP support and constructive challenges that prompted them to take responsibility for relationship improvements.

CONCLUSION

Patients value their GPs' holistic, supportive, and direct approach in addressing couple relationship problems, although they perceive that GPs do not always have sufficient time. They welcome relevant challenges that can drive positive change.

Translational Approach to Social Isolation During a Global Pandemic: Hippocampal Somatic Mutation and Stress

OBJECTIVE

The coronavirus disease-2019 (COVID-19) pandemic's social isolation has significantly impacted mental health, increasing depression and anxiety. This study explores the effects of social isolation on both humans and mice, focusing on behavioral changes and hippocampal protein expression. It also investigates genetic alterations through single-cell RNA and whole-genome sequencing (WGS).

METHODS

Here we conducted behavioral studies, protein expression studies, single-nucleus sequencing (snRNAseq), and WGS of the hippocampus of mice that underwent early maternal separation and social isolation, and a demographic study of community populations who had been self-quarantined owing to COVID-19 exposure to investigate the link between somatic mutations and stress due to social isolation.

RESULTS

The demographic study demonstrated more negative mental health findings among individuals who live alone or are single. Mice subjected to early maternal separation and social isolation demonstrated increased anxiety-like behaviors and stress-related corticotropin-releasing hormone receptor 1, and neurogenesis-related sex-determining region Y-box 2 and doublecortin expression. In snRNA-seq, differences, such as transthyretin increase, were observed in the maternal separation group, and somatic mutations, including insertion in the intron site of Tmem267, were observed in the social isolation group on WGS.

CONCLUSION

The results of this study suggest that stress, such as social isolation, can cause changes at the genetic level, as well as behavioral and brain protein changes.

Associations between mental illness, TB risk and migrant status

BACKGROUND

TB and mental illnesses are public health priorities that often co-exist, with migrants in high-income countries being at risk for both conditions. This study investigates whether mental illness influences TB risk and examines the impact of migration status.

METHODS

A nationwide prospective cohort study was conducted in Denmark from 1994-2015, involving migrants matched 1:6 to Danish-born individuals. Cox regression models, adjusted for age, sex and migrant status, were used to assess the effect of mental disorders on TB risk.

RESULTS

Both migrants and non-migrants with mental disorders showed elevated TB incidence (n = 1,189,273). After adjusting for age and sex, the hazard ratio (HR) for TB in those with any mental disorder was 3.62 (95% CI 2.99-4.39, P < 0.001) compared to those without mental disorders. The effect was more substantial in Danish-born individuals (HR 15.51, 95% CI 12.05-19.95, P < 0.001) than in migrants (HR 1.37, 95% CI 0.99-1.90, P = 0.055). Sub-analyses highlighted a significant effect of substance use (HR 5.49, 95% CI 4.46-6.76, P < 0.001) and psychosis (HR 4.19, 95% CI 1.74-10.08, P = 0.001) and borderline significance for affective/anxiety/stress-related disorders (HR 1.64, 95% CI 0.98-2.73, P = 0.058) on TB risk.

CONCLUSIONS

People with mental illnesses, particularly psychotic and substance use disorders, have increased TB incidence and represent a high-risk population for targeted screening and treatment. TB programmes should integrate holistic mental health care.

A Brief Historic Review of Research on Early Life Stress and Inflammation across the Lifespan

BACKGROUND

Extensive evidence from animal and human studies indicates that exposure to stress during sensitive developmental periods significantly increases the risk for psychiatric and physical disorders, resulting in reduced longevity. Chronic immune activation has been suggested as one pathway through which early adverse experiences may become biologically embedded. This paper highlights selected key findings and questions that first emerged in the literature and founded the field and then examines how research methods and questions have evolved over time.

SUMMARY

During the past decades, evidence from preclinical, clinical, and epidemiological studies has accumulated suggesting consequences of early life stress (ELS) exposure for immune function, particularly increased chronic inflammation or inflammatory responses. Scientific approaches to study the effects of ELS on the immune system have changed since the first studies on this topic were published.

KEY MESSAGES

Across different study designs, species, and methods, a consistent association between childhood adversity and a pro-inflammatory phenotype has been reported. We critically discuss which topics warrant further consideration and how current findings could be used to develop targeted interventions to prevent or reverse the biological embedding of ELS and resultant disease manifestations.

A Narrative Review on Stress and Itch: What We Know and What We Would Like to Know

Itch is one of the most prevalent symptoms experienced by patients with inflammatory skin conditions, yet it is also one of the most debilitating. Patients suffering from chronic itch have been found to have significantly higher stress levels compared with those not experiencing itch. In fact, recent studies have revealed a bidirectional relationship between stress and itch, where each condition worsens the other. This is thought to be driven by the vicious itch-scratch cycle, which is fueled by underlying inflammation. The precise molecular pathways and mediators involved, however, remain unclear. This narrative review discusses the existing research on the relationship between stress and itch and outlines future research directions that will be necessary to advance our understanding and treatment of these conditions. Given that the effective management of both symptoms often requires a combined treatment approach, further investigation into their shared mechanisms is essential for identifying successful therapies and improving patient outcomes.

Behavioral coping with chronic defeat stress in mice: A systematic review of current protocols

Social stress is the most significant source of chronic stress in humans and is commonly associated with health impairment. Individual differences in the behavioral coping responses to stress have been proposed to mediate the negative effects of stress on physical, behavioral and mental health. Animal models, particularly mice, offer valuable insights into the physiological and neurobiological correlates of behavioral coping strategies in response to chronic social stress. Here we aim to identify differences and similarities among stress protocols in mice, with particular attention to how neuroendocrine and/or behavioral responses vary according to different coping strategies, while highlighting the need for standardized approaches in future research. A systematic review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA statement). A total of 213 references were identified by electronic search, and after the screening, 18 articles were found to meet all the established criteria. We analyzed differences in the stress protocol, the characterization and classification of coping strategies and the physiological and behavioral differences according to coping. The results show that differences in behavioural expression under chronic social stress (coping) may also be associated with physiological differences and differential susceptibility to disease. However, this review also underlines the importance of a cautious interpretation of the results obtained. The lack of consistency in the nomenclature and procedures associated with the study of coping strategies for social stress, as well as the absence of a uniform classification, highlight the importance of using a common language when approaching the study of coping strategies. Thereby, this review encourages the development of a more defined method and criteria for assessing coping strategies, based on both behavioral and biological indicators.

Chronic Rhinosinusitis and Mental Health

Importance

Chronic rhinosinusitis (CRS) has been associated with anxiety and depression, but the association of socioeconomic factors and temporality has yet to be fully explored.

Objective

To determine the bidirectional risk of anxiety and depression for patients with CRS.

Design, Setting, and Participants

This retrospective cohort study of the National Institutes of Health All of Us database from January 1, 2008, to December 31, 2018, included 2 cohorts of adult patients with and without CRS. The data were analyzed from July 1, 2023, through April 1, 2024. Patients were classified as having CRS if they had at least 2 diagnoses during the study period. Those with a diagnosis of CRS before the study period were excluded. Patients were propensity score matched (1:5) with patients without CRS for age, sex, race, and annual household income.

Main Outcomes and Measures

The primary outcome was the development of anxiety and depression. Patients with CRS were counted as having the primary outcome if it occurred after the criteria for CRS diagnosis were fulfilled. Multivariate logistic regression and survival analysis were performed to determine the odds ratios (ORs) and hazard ratios (HRs) of anxiety and depression. A secondary survival analysis determined the risk of developing CRS between patients with anxiety and depression and controls.

Results

Among 33 732 patients (23 382 [69.3%] female individuals; 510 [1.5%] Asian, 6002 [17.9%] Black or African American, 576 [1.7%] multiracial, and 26 036 [77.2%] White individuals), there were 28 110 controls and 5622 patients with CRS. Along with higher odds of having anxiety (OR, 4.39; 95% CI, 3.95-4.87) and depression (OR, 2.04; 95% CI, 1.86-2.24), patients with CRS were at an increased risk of developing anxiety (HR, 2.79; 95% CI, 2.47-3.15) and depression (HR, 1.40; 95% CI, 1.27-1.55) compared with controls. Additionally, patients with anxiety (HR, 2.37; 95% CI, 2.18-2.57) and depression (HR, 1.59; 95% CI, 1.46-1.72) were at an increased risk of developing chronic rhinosinusitis compared with controls.

Conclusions and Relevance

In this population-based cohort study of adults with and without CRS, a bidirectional association between common psychiatric disorders and CRS was observed. Physicians and health care clinicians who treat patients with anxiety, depression, and CRS should be vigilant regarding these risks and screen patients appropriately.

The post-Cartesian dilemma: Reuniting the mind and body through psychoneuroimmunology

While today, it might seem absurd to hear anyone claim that stress does not alter all aspects of the human experience, including behavioral, cognitive, affective, and physiological processes. Dr. Janice Kiecolt-Glaser started her career at a time when stress was primarily considered a neuroendocrine response with cardiovascular repercussions. She was part of a small group of innovative scientists who began to push the boundaries of stress research - many contemporary immunologists and virologist disputed their early results in 1980s and 90s - and, yet, they persevered by connecting psychological stress to altered immune function via stress-related neuroendocrine changes. As a clinical psychologist, she focused mainly on human research studies to advance the field of psychoneuroimmunology throughout her career. Her research demonstrates how adversity and psychosocial aspects of human experience alter physiological functioning, primarily immune, and health or, in other words, the embodiment of our lived experiences. This short review is a contextualized synthesis of Dr. Kiecolt-Glaser's key contributions to the fields of psychoneuroimmunology and health psychology and her influence on my present day thinking and research approaches, as well as potential steps forward in our post-pandemic world.

Diversity of ancestral brainstem noradrenergic neurons across species and multiple biological factors

The brainstem region, locus coeruleus (LC), has been remarkably conserved across vertebrates. Evolution has woven the LC into wide-ranging neural circuits that influence functions as broad as autonomic systems, the stress response, nociception, sleep, and high-level cognition among others. Given this conservation, there is a strong possibility that LC activity is inherently similar across species, and furthermore that age, sex, and brain state influence LC activity similarly across species. The degree to which LC activity is homogenous across these factors, however, has never been assessed due to the small sample size of individual studies. Here, we pool data from 20 laboratories (1,855 neurons) and show diversity across both intrinsic and extrinsic factors such as species, age, sex and brain state. We use a negative binomial regression model to compare activity from male monkeys, and rats and mice of both sexes that were recorded across brain states from brain slices ex vivo or under different anesthetics or during wakefulness in vivo. LC activity differed due to complex interactions of species, sex, and brain state. The LC became more active during aging, independent of sex. Finally, in contrast to the foundational principle that all species express two distinct LC firing modes ("tonic" or "phasic"), we discovered great diversity within spontaneous LC firing patterns. Different factors were associated with higher incidence of some firing modes. We conclude that the activity of the evolutionarily-ancient LC is not conserved. Inherent differences due to age and species-sex-brain state interactions have implications for understanding the role of LC in species-specific naturalistic behavior, as well as in psychiatric disorders, cardiovascular disease, immunology, and metabolic disorders.

Impact of Six Months of Three Different Modalities of Exercise on Stress in Post-Treatment Breast Cancer Survivors

BACKGROUND/OBJECTIVES

Extensive evidence suggests that exercise is physically and mentally beneficial for cancer survivors. This study reports on changes in self-reported stress, physiological biomarkers for stress (salivary cortisol), and HR-QOL constructs for fifty breast cancer survivors participating in one of three different exercise programs over 6 months.

METHODS

Fifty post-treatment breast cancer survivors were randomized to either therapeutic yoga-based exercise (YE), comprehensive exercise (CE) (aerobic, resistance, flexibility), or choosing (C) their own exercise activities. Participants completed the Perceived Stress Scale (PSS), Medical Outcomes Short-Form 36® (SF-36), and the Pittsburgh Sleep Quality Index (PSQI). Five samples of salivary cortisol were collected on two consecutive days. The 10 samples were used to calculate the diurnal rhythm slope. Outcome measures were repeated after six months.

RESULTS

All groups improved in HR-QOL measures of PSS; PSQI sleep quality components of latency and daytime functioning; and five of the ten SF-36 scales (Mental Component Scale, Social Functioning subscale, Mental Health subscale, Physical Component Scale, Physical Functioning subscale). Although the CE group observed the most favorable change in cortisol (-0.183), where cortisol slope changes approached significance (p = 0.057), but no significant decrease in cortisol between groups were noted.

CONCLUSIONS

Our results suggest that it is the engagement of, rather than the specific type of exercise, which is associated with improved HR-QOL. However, longer-term studies with better adherence monitoring and larger sample sizes are needed to better determine clinical impact.

Can social adversity alter the epigenome, trigger oral disease, and affect future generations?

The nature versus nurture debate has intrigued scientific circles for decades. Although extensive research has established a clear relationship between genetics and disease development, recent evidence has highlighted the insufficiency of attributing adverse health outcomes to genetic factors alone. In fact, it has been suggested that environmental influences, such as socioeconomic position (SEP), may play a much larger role in the development of disease than previously thought, with extensive research suggesting that low SEP is associated with adverse health conditions. In relation to oral health, a higher prevalence of caries (tooth decay) exists among those of low SEP. Although little is known about the biological mechanisms underlying this relationship, epigenetic modifications resulting from environmental influences have been suggested to play an important role. This review explores the intersection of health inequalities and epigenetics, the role of early-life social adversity and its long-term epigenetic impacts, and how those living within the lower hierarchies of the socioeconomic pyramid are indeed at higher risk of developing diseases, particularly in relation to oral health. A deeper understanding of these mechanisms could lead to the development of targeted interventions for individuals of low SEP to improve oral health or identify those who are at higher risk of developing oral disease.

Stress as a possible trigger in anti-N-methyl-ᴅ-aspartate receptor encephalitis: a case series

Anti-N-methyl-ᴅ-aspartate receptor (NMDAR) encephalitis is a rare disease with a range of neurological and psychiatric presentations. Antibodies against NMDAR receptor are purported to be pathologic, and the two known potential immunological triggers are tumors and viral infection. In half of the cases, the trigger is not known. We present two cases where stress seemed to have triggered encephalitis. These cases illustrate the possible role of stress in leading to immune dysregulation, which can lead to encephalitis. We review the role of stress in anti-NMDAR encephalitis and possible mechanisms by which stress can trigger an immune dysregulation.

Glucocorticoid receptors orchestrate a convergence of host and cellular stress signals in triple negative breast cancer

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer that lacks expression of the nuclear steroid receptors that bind estrogens (ER) and progestogens (PRs) and does not exhibit HER2 (Human epidermal growth factor 2) receptor overexpression. Even in the face of initially effective chemotherapies, TNBC patients often relapse. One primary cause for therapy-resistant tumor progression is the activation of cellular stress signaling pathways. The glucocorticoid receptor (GR), a corticosteroid-activated transcription factor most closely related to PR, is a mediator of both endocrine/host stress and local tumor microenvironment (TME)-derived and cellular stress responses. Interestingly, GR expression is associated with a good prognosis in ER+ breast cancer but predicts poor prognosis in TNBC. Classically, GR's transcriptional activity is regulated by circulating glucocorticoids. Additionally, GR is regulated by ligand-independent signaling events. Notably, the stress-activated protein kinase, p38 MAP kinase, phosphorylates GR at serine 134 (Ser134) in response to TME-derived growth factors and cytokines, including HGF and TGFβ1. Phospho-Ser134-GR (p-Ser134-GR) associates with cytoplasmic and nuclear signaling molecules, including 14-3-3ζ, aryl hydrocarbon receptors (AhR), and hypoxia-inducible factors (HIFs). Phospho-GR/HIF-containing transcriptional complexes upregulate gene sets whose protein products include the components of inducible oncogenic signaling pathways (PTK6) that further promote cancer cell survival, chemoresistance, altered metabolism, and migratory/invasive behavior in TNBC. Recent studies have implicated liganded p-Ser134-GR (p-GR) in dexamethasone-mediated upregulation of genes related to TNBC cell motility and dysregulated metabolism. Herein, we review the tumor-promoting roles of GR and discuss how both ligand-dependent and ligand-independent/stress signaling-driven inputs to p-GR converge to orchestrate metastatic TNBC progression.

Having any mental health condition before the COVID-19 pandemic as a risk factor of COVID-19 contagion during the first year of pandemic: A Spanish adult cohort

Numerous studies suggest that subjects suffering from a mental health condition before the COVID-19 pandemic were at higher risk of contagion, but mostly are cross-sectional or retrospective. The BIOVAL-D-COVID-19 is a longitudinal cohort study design with 922 subjects who full filled two evaluations from an online survey of Spanish residents before and during the pandemic. Mental health conditions assessed were: Major Depressive Episode (MDE), Generalised Anxiety Disorder (GAD), Suicidal Thoughts and Behaviours (STB) and subthreshold of panic and bipolar disorder (BD). Mental health screening instruments used were: the Spanish version of the Composite International Diagnostic Interview (CIDI) version 3.0 for the evaluation of MDE, the GAD-7 scale to evaluate GAD; STB was evaluated with four items from the CIDI questionnaire. Panic Disorder and BD were screened from a modified and self-reported version of the CIDI. A bivariate plus five logistic regression models were developed for each mental health condition adjusted by socio-demographic variables; employment status; general and physical health; comorbidity; and including all previous variables and the other mental health conditions. We found in bivariate model that MDE; GAD and STB were statistically significant risk factors of contagion of COVID-19. The logistic regression models developed reveal that having a previous GAD (aOR 3.30 1.31-8.31) or STB (aOR 2.16 CI 95% 1.01-4.62) was statistically significant associated with COVID-19 contagion, independently of all variables included. MDE was not a risk factor of contagion when it was adjusted by comorbidity (aOR 0.99 CI 95% 0.47-2.09). It is recommended to detect those subjects with previous GAD or STB as vulnerable groups of infection to reduce contagion rates.

Usutu virus, an emerging arbovirus with One Health importance

Usutu virus (USUV, Flaviviridae) is an emerging arbovirus that has led to epizootic outbreaks in birds and numerous human neuroinvasive disease cases in Europe. It is maintained in an enzootic cycle with Culex mosquitoes and passerine birds, a transmission cycle that is shared by West Nile virus (WNV) and St. Louis encephalitis virus (SLEV), two flaviviruses that are endemic in the United States. USUV and WNV co-circulate in Africa and Europe, and SLEV and WNV co-circulate in North America. These three viruses are prime examples of One Health issues, in which the interactions between humans, animals, and the environments they reside in can have important health impacts. The three facets of One Health are interwoven throughout this article as we discuss the mechanisms of flavivirus transmission and emergence. We explore the possibility of USUV emergence in the United States by analyzing the shared characteristics among USUV, WNV, and SLEV, including the role that flavivirus co-infections and sequential exposures may play in viral emergence. Finally, we provide insights on the importance of integrated surveillance programs as One Health tools that can be used to mitigate USUV emergence and spread.

Social and humanitarian issues in nephrology and hypertension

PURPOSE OF REVIEW

Chronic kidney disease and hypertension, two widely prevalent conditions worldwide, present an urgent and pressing need for immediate action. The review describes how social conditions and humanitarian issues can influence hypertension and kidney disease.

RECENT FINDINGS

Undoubtedly, social determinants of health (SDoH) are key influencers in the development of many noncommunicable diseases, including hypertension and kidney disease. Healthcare professionals, including public health workers, play a crucial role in addressing these issues. Poverty, low education level, poor nutrition, housing, exposure to environmental hazards, and stress-related disorders are all factors that can be addressed, either directly or indirectly, through improved awareness and access to proper healthcare services. Besides personal factors, national, regional, or global factors cause serious apprehension. Disasters, whether natural or man-made, can lead to significant aftermaths on the healthy person and certainly on kidney disease and hypertensive patients. A Global Overview Report, 2023 turned out to be one of the most violent years since the end of the Cold War. In 2023, 59 state-based conflicts were recorded in 34 countries, the highest number registered since 1946. The wars in Ukraine and Gaza were the primary contributors with a significant impact on the kidney population, especially people living on dialysis and transplantation patients. They also yielded many refugees or displaced persons with ongoing suffering.

SUMMARY

It is crucial to recognize that social and humanitarian conditions can quickly exacerbate the health of vulnerable populations, particularly those with noncommunicable diseases like hypertension and chronic kidney disease. These patients, who often require continuous follow-up, especially those on dialysis, are particularly vulnerable during difficult times. Their lives depend on uninterrupted access to dialysis or transplantation medications, making the need for special attention and care more pressing. Further research and advocacy are needed to address these issues and ensure the health and well being of these populations.

Assessing Fecal Microbial Diversity and Hormone Levels as Indicators of Gastrointestinal Health in Reintroduced Przewalski's Horses (Equus ferus przewalskii)

Diarrhea serves as a vital health indicator for assessing wildlife populations post-reintroduction. Upon release into the wild, wild animals undergo adaptation to diverse habitats and dietary patterns. While such changes prompt adaptive responses in the fecal microbiota, they also render these animals susceptible to gastrointestinal diseases, particularly diarrhea. This study investigates variations in fecal microorganisms and hormone levels between diarrhea-afflicted and healthy Przewalski's horses. The results demonstrate a significant reduction in the alpha diversity of the fecal bacterial community among diarrheal Przewalski's horses, accompanied by notable alterations in taxonomic composition. Firmicutes, Proteobacteria, and Bacteroidetes emerge as dominant phyla across all fecal samples, irrespective of health status. However, discernible differences in fecal bacterial abundance are observed between healthy and diarrhea-stricken individuals at the genus level, specifically, a diminished relative abundance of Pseudobutyrivibrio is observed. The majority of the bacteria that facilitate the synthesis of short-chain fatty acids, Christensenellaceae_R_7_group (Christensenellaceae), NK4A214_group (Ruminococcus), Lachnospiraceae_XPB1014_group (Lachnospiraceae), [Eubacterium]_coprostanoligenes_group (Eubacterium), Rikenellaceae_RC9_gut_group, Lachnospiraceae_AC2044_group (Lachnospiraceae), and Prevotellaceae_UcG_001 (Prevotella) are noted in diarrhea-affected Przewalski's horses, while Erysipelotrichaceae, Phoenicibacter, Candidatus_Saccharimonas (Salmonella), and Mogibacterium are present in significantly increased amounts. Moreover, levels of immunoglobulin IgA and cortisol are significantly elevated in the diarrhea group compared with the non-diarrhea group. Overall, this study underscores substantial shifts in fecal bacterial diversity, abundance, and hormone levels in Przewalski's horses during episodes of diarrhea.

Influence of stress-specific interventions on biomarker levels and cognitive function in cancer patients: Systematic review and meta-analysis

PURPOSE

Cancer patients' psycho-physiological health is seriously affected by long-term exposure to stress. Many studies have explored the impact of stress-specific interventions on cancer patients' biomarker levels and cognitive functions. However, the current research findings are inconsistent, and their statistical power is limited by the small samples. Therefore, we conducted this meta-analysis to verify the effect of stress-specific interventions on cancer patients.

METHODS

The literature involved nine databases from the inception until January 13, 2024, extracted 19 randomized controlled trials (RCTs). Review Manager (RevMan) 5.4 software was used to perform a meta-analysis, and the revised Cochrane risk of bias tool (RoB2) was utilized for quality evaluation.

RESULTS

Nine RCTs were assessed as having a low risk of bias, and others had a moderate risk. The results showed that stress-specific interventions had beneficial effects on patients' subjective cognition but uncertain impacts on their executive function, tumour necrosis factor-α level, morning cortisol level, and no effect on cortisol at other times, interleukin (IL)-10, IL-8, IL-6, IL-1, and C-reactive protein.

CONCLUSION

More rigorous studies are required to elucidate the influence of stress-specific interventions on biomarker levels. The potential mechanism by which stress-specific interventions affect the cancer patient's cognitive function remains unclear.

Tailor-made molecular imprints for biological event intervention

Molecular imprints, which are crosslinked architectures containing specific molecular recognition cavities for targeting compounds, have recently transitioned from in vitro diagnosis to in vivo treatment. In current application scenarios, it has become an important topic to create new biomolecular recognition pathways through molecular imprinting, thereby inhibiting the pathogenesis and regulating the development of diseases. This review starts with a pathological analysis, mainly focusing on the corresponding artificial enzymes, enzyme inhibitors and antibody mimics with enhanced functions that are created by molecular imprinting strategies. Recent advances are highlighted in the use of molecular imprints as tailor-made nanomedicines for the prevention of three major diseases: metabolic syndrome, cancer, and bacterial/viral infections.

Neural Correlates of Early-Life Urbanization and Their Spatial Relationships with Gene Expression, Neurotransmitter, and Behavioral Domain Atlases

Previous neuroimaging research has established associations between urban exposure during early life and alterations in brain function and structure. However, the molecular mechanisms and behavioral relevance of these associations remain largely unknown. Here, we aimed to address this question using a combined analysis of multimodal data. Initially, we calculated amplitude of low-frequency fluctuations (ALFF) and gray matter volume (GMV) using resting-state functional and structural MRI to investigate their associations with early-life urbanization in a large sample of 511 healthy young adults. Then, we examined the spatial relationships of the identified neural correlates of early-life urbanization with gene expression, neurotransmitter, and behavioral domain atlases. Results showed that higher early-life urbanization scores were correlated with increased ALFF of the right fusiform gyrus and decreased GMV of the left dorsal medial prefrontal cortex and left precuneus. Remarkably, the identified neural correlates of early-life urbanization were spatially correlated with expression of gene categories primarily involving immune system process, signal transduction, and cellular metabolic process. Concurrently, there were significant associations between the neural correlates and specific neurotransmitter systems including dopamine, acetylcholine, and serotonin. Finally, we found that the ALFF correlates were associated with behavioral terms including "perception," "sensory," "cognitive control," and "reasoning." Apart from expanding existing knowledge of early-life urban environmental risk for mental disorders and health in general, our findings may contribute to an emerging framework for integrating social science, neuroscience, genetics, and public policy to respond to the major health challenge of world urbanization.