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Wu B, Lu J, Wei D, Wang C, Mao Z, Liu P. The association of cortisol, testosterone, and cortisol/testosterone ratio with stroke: A cross-sectional study. J Stroke Cerebrovasc Dis 2024; 33:107821. [PMID: 38878843 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 07/15/2024] Open
Abstract
AIMS We aimed to investigate the association between serum cortisol, testosterone, and cortisol/testosterone (C/T) ratio and stroke. MATERIALS AND METHODS A total of 6157 subjects were included in this study. The serum levels of cortisol and testosterone were determined by liquid chromatography-tandem mass spectrometry method. The relationships of serum cortisol, testosterone, and C/T ratio levels with the odds ratios (ORs) of stroke were calculated using logistic regression analysis. The dose-response associations between serum cortisol, testosterone, and C/T ratio levels with stroke estimated by restricted cubic splines. RESULTS After adjusting for multiple variables, serum testosterone levels were negactively associated with stroke in males (per 1 unit, odds ratio (OR) = 0.83, 95 % confidence interval (CI): 0.70, 0.97). The serum C/T ratio is positively associated with stroke in both males and females (OR = 1.16, 95 % CI:1.04,1.34 in males and OR = 1.15, 95 % CI:1.02,1.31 in females). Restricted cubic splines showed a significant linear dose-response relationship between testosterone and C/T ratio and stroke in males (P for overall association <0.05, P for nonlinearity >0.05). CONCLUSION Our study findings show that serum testosterone levels are negatively correlated with stroke in males; meanwhile, serum C/T ratio is positively correlated with stroke in both males and females.
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Affiliation(s)
- Beibei Wu
- The Fifth Affiliated Hospital of Zhengzhou University, Henan, PR China
| | - Jianyuan Lu
- Xinxiang Municipal Government Hospital, Henan, PR China
| | - Dandan Wei
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, PR China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, PR China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou 450001, Henan, PR China.
| | - Pengling Liu
- Zhengzhou Seventh People's Hospital Medical Affairs Department, No. 17 Jingnan 5th Road, Zhengzhou, 450016, Henan, PR China.
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Morris AA, Masoudi FA, Abdullah AR, Banerjee A, Brewer LC, Commodore-Mensah Y, Cram P, DeSilvey SC, Hines AL, Ibrahim NE, Jackson EA, Joynt Maddox KE, Makaryus AN, Piña IL, Rodriguez-Monserrate CP, Roger VL, Thorpe FF, Williams KA. 2024 ACC/AHA Key Data Elements and Definitions for Social Determinants of Health in Cardiology: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Data Standards. J Am Coll Cardiol 2024:S0735-1097(24)07404-7. [PMID: 39207317 DOI: 10.1016/j.jacc.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
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Shkoruta DP, Senkiv V, Vovchuk V, Popadynets O, Kotyk T. Impact of war on stroke incidence in Ivano-Frankivsk, Ukraine. Sci Rep 2024; 14:18996. [PMID: 39152236 PMCID: PMC11329696 DOI: 10.1038/s41598-024-70270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
Stroke is an extensive health problem in Ukraine, the prominence and effects of which are aggravated by the burden of the ongoing Russo-Ukrainian War. In this study, we aimed to holistically examine the overall stroke epidemiology in Ivano-Frankivsk using data from a secondary healthcare center in the city. We determine an increasing trend in stroke admissions since 2020, with a notable 22.4% increase in 2023, mainly due to ischemic stroke occurrence. In the same year, a significant non-linear relationship between stroke incidence and frequency of news about attacks was observed. Ordinal regression analysis of general sociodemographic, clinical, and healthcare-related factors influencing outcomes for intravenous thrombolysis-treated patients, revealed the significance of the 24-h National Institutes of Health Stroke Scale score (0.32 ± 0.03) and interaction of age and Door-to-Needle Time (- 0.28 ± 0.08). However, the extension of the latter independently is not significantly correlated with patient outcomes. In conclusion, war-induced stress, intranational migrations, and lack of adequate chronic cardiovascular disease management are primarily responsible for these results. Modulations and improvements to the current healthcare system, including managing chronic diseases and early stroke symptom recognition, are necessary to optimize patient outcomes.
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Affiliation(s)
- Dominika Paula Shkoruta
- Department of Human Anatomy, Ivano-Frankivsk National Medical University, Halytska 2, Ivano-Frankivsk, 76018, Ukraine
| | - Vasylyna Senkiv
- Department of Human Anatomy, Ivano-Frankivsk National Medical University, Halytska 2, Ivano-Frankivsk, 76018, Ukraine
| | - Volodymyr Vovchuk
- Ivano-Frankivsk Central City Clinical Hospital, Mazepy 114, Ivano-Frankivsk, 76018, Ukraine
- Department of Social Medicine and Public Health, Ivano-Frankivsk National Medical University, Halytska 2, Ivano-Frankivsk, 76018, Ukraine
| | - Oksana Popadynets
- Department of Human Anatomy, Ivano-Frankivsk National Medical University, Halytska 2, Ivano-Frankivsk, 76018, Ukraine
| | - Taras Kotyk
- Department of Human Anatomy, Ivano-Frankivsk National Medical University, Halytska 2, Ivano-Frankivsk, 76018, Ukraine.
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Canavero I, Storti B, Marinoni G, De Souza DA, Moro E, Gatti L, Sacco S, Lorenzano S, Sandset EC, Poggesi A, Carrozzini T, Pollaci G, Potenza A, Gorla G, Wardlaw JM, Zedde ML, Bersano A. COVID-19 and stroke in women: impact on clinical, psychosocial and research aspects. Neurol Sci 2024:10.1007/s10072-024-07716-0. [PMID: 39103735 DOI: 10.1007/s10072-024-07716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024]
Abstract
Despite the growing interest in gender medicine, the influence of sex and gender on human diseases, including stroke, continues to be underestimated and understudied. The COVID-19 pandemic has overall impacted not only the occurrence and management of stroke but has also exacerbated sex and gender disparities among both patients and healthcare providers. This paper aims to provide an updated overview on the influence of sex and gender in stroke pathophysiology and care during COVID-19 pandemic, through biological, clinical, psychosocial and research perspectives. Gender equity and awareness of the importance of sexual differences are sorely needed, especially in times of health crisis but have not yet been achieved to date. To this purpose, the sudden yet worldwide diffusion of COVID-19 represents a unique learning experience that highlights critical unmet needs also in gender medicine. The failures of this recent past should be kept as food for thought to inspire proper strategies reducing inequalities and to address women's health and wellbeing issues, particularly in case of future pandemics.
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Affiliation(s)
- Isabella Canavero
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Benedetta Storti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Giulia Marinoni
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Diana Aguiar De Souza
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, CHULN, University of Lisbon, Lisbon, Portugal
| | - Elena Moro
- Division of Neurology, CHU Grenoble Alpes, Grenoble Institute of Neuroscience, Grenoble Alpes University, Grenoble, France
| | - Laura Gatti
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Else C Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Anna Poggesi
- NEUROFARBA Department, University of Florence, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
- Don Carlo Gnocchi Foundation, Florence, Italy
| | - Tatiana Carrozzini
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Giuliana Pollaci
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Antonella Potenza
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Gemma Gorla
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Maria Luisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, 20133, Italy.
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Usama SM, Kothari YL, Karthikeyan A, Khan SA, Sarraf M, Nagaraja V. Social Isolation, Loneliness, and Cardiovascular Mortality: The Role of Health Care System Interventions. Curr Cardiol Rep 2024; 26:669-674. [PMID: 38713361 DOI: 10.1007/s11886-024-02066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE OF REVIEW The world is proliferating rapidly, with science and technology advancing at an incredible rate. These advances have, however, ushered in an age with a rise in social isolation (SI) and loneliness. SI is an objective term that refers to lacking social contact or support. On the other hand, loneliness is subjective and refers to feeling alone or isolated. These concepts are rapidly gaining prominence mainly due to their negative impact on the physical and psychological health of the population, mainly through behavioural modifications that encompass substance abuse, decreased physical activity and unhealthy food habits, and poor sleep hygiene. This review summarizes the pathophysiology, evaluates the evidence behind impact of SI on cardiovascular mortality, and interventions to overcome SI. RECENT FINDINGS Through proposed mechanisms, such as activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, both SI and loneliness have strong evidence linking them to cardiovascular morbidity and mortality. A systematic review and meta-analysis of 90 prospective cohort studies including 2,205,199 individuals reported that SI was independent predictor of cardiovascular mortality with a point estimate of 1.34 (95% confidence interval:1.25-1.44). The evidence so far is compelling and necessitates urgent action with the implementation of strict policies to tackle this issue. As healthcare professionals, it becomes even more critical to remain vigilant, recognize this insidious pandemic, and take appropriate action.
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Affiliation(s)
| | - Yash Lalit Kothari
- Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | | | - Syed Anjum Khan
- Department of Critical Care Medicine, Mayo Clinic Health System - Southwest Minnesota Region, Mankato, MN, USA
| | - Mohammad Sarraf
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Vinayak Nagaraja
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
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Ajibewa TA, Kershaw KN, Carr JJ, Terry JG, Gabriel KP, Carnethon MR, Wong M, Allen NB. Chronic Stress and Cardiovascular Events: Findings From the CARDIA Study. Am J Prev Med 2024; 67:24-31. [PMID: 38143043 PMCID: PMC11193648 DOI: 10.1016/j.amepre.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Higher levels of perceived stress are associated with adverse cardiovascular health. It is plausible that these associations are attenuated among individuals with positive psychological factors such as social support and health-enhancing behaviors. Therefore, this study examined longitudinal associations of chronic stress with cardiovascular disease (CVD) events, and whether social support and physical activity (PA) modify these associations. METHODS Data from 3,401 adults (mean age 40.2 years; 46.7% Black; 56.2% women) from the Coronary Artery Risk Development in Young Adults (CARDIA) study, with no prior CVD event in 2000-2001 were analyzed. Chronic stress lasting ≥6 months across 5 life domains (work, financial, relationships, health of self, and health of close other) was self-reported. Adjudicated CVD events (fatal/or nonfatal CVD event) were ascertained yearly through 2020. PA and social support were self-reported via questionnaires. Statistical analyses were conducted in 2023 using multivariable stepwise Accelerated Failure Time analysis to assess associations between key study variables. RESULTS The mean chronic stress score was 1.30±1.33 stressors and, by 2020, 220 participants had experienced a CVD event. Chronic stress was associated with lowered survival (time ratio: 0.92; 95% CI: 0.854-0.989), when adjusted for sociodemographic and lifestyle variables but no longer significant when adjusting for clinical factors. Neither PA nor social support were significant modifiers (all ps>0.05). CONCLUSIONS Chronic stress was associated with the risk of having a CVD event among middle-aged adults, due at least in part to clinical mediators. Studies should continue exploring positive psychosocial and behavioral factors that may modify this association.
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Affiliation(s)
| | - Kiarri N Kershaw
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J Jeffrey Carr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - James G Terry
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Mandy Wong
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Norrina B Allen
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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7
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von Känel R. Stress-Induced Hypercoagulability: Insights from Epidemiological and Mechanistic Studies, and Clinical Integration. Semin Thromb Hemost 2024. [PMID: 38914118 DOI: 10.1055/s-0044-1787660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
By integrating findings from comprehensive reviews, meta-analyses, and cutting-edge genetic studies, this article illuminates the significance of stress-induced hypercoagulability in clinical medicine. In particular, the findings from numerous prospective cohort studies indicate that stress and hemostatic factors of a hypercoagulable state are associated with increased incident risk and poor prognosis for atherosclerotic cardiovascular disease and venous thromboembolism. Mendelian randomization studies suggest that these associations are partially causal. The review synthesizes extensive research on the link between acute and chronic stress and hypercoagulability, outlining a potential pathway from stress to thrombosis risk. Consistent with the allostatic load concept, acute stress-induced hypercoagulability, initially adaptive, can turn maladaptive under chronic stress or excessive acute stress, leading to arterial or venous thrombotic events. Individuals with predisposing factors, including atherosclerosis, thrombophilia, or immobilization, may exhibit an increased risk of thrombotic disease during stress. Contextual sociodemographic characteristics, the stress experience, and coping resources additionally modulate the extent of stress-induced hypercoagulability. Research into the neuroendocrine, cellular, and molecular bases reveals how stress influences platelet activation coagulation and fibrinolysis. The activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, along with vagal withdrawal, and the effects of catecholamines, cortisol, and vasopressin, are the central mechanisms involved. Hemoconcentration, inflammation, endothelial dysfunction, and thrombopoiesis additionally contribute to stress-induced hypercoagulability. Further research is needed to prove a causal link between chronic stress and hypercoagulability. This includes exploring its implications for the prevention and management of thrombotic diseases in stressed individuals, with a focus on developing effective psychosocial and pharmacological interventions.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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8
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Jang EH, Jung R, Lee S. Higher adherence to a Mediterranean-type diet is associated with reduced psychosocial stress levels in baby boomers: a cross-sectional study. Nutr Res Pract 2024; 18:257-268. [PMID: 38584810 PMCID: PMC10995775 DOI: 10.4162/nrp.2024.18.2.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND/OBJECTIVES This study investigated the relationship between adherence to the Mediterranean diet among Korean baby boomers and their levels of psychosocial stress. SUBJECTS/METHODS The study included 1,656 adults (889 men and 797 women) born between 1955 and 1963 who participated in the 2005-2006 survey of the community-based Korean Genome and Epidemiology Study (KoGES). The Mediterranean-type diet score (MTDS) was calculated from the semi-quantitative food frequency questionnaire (SQFFQ) data. The psychosocial stress levels were calculated using the psychosocial well-being index-short form (PWI-SF). Logistic regression analyses were performed to analyze the association between the MTDS (tertiles) and the prevalence of high psychosocial stress by gender. RESULTS The ranges of the MTDS tertile groups were T1 (20-33 points), T2 (34-37 points), and T3 (38-39 points) for men, T1 (20-33 points), T2 (34-37 points), and T3 (38-48 points) for women. In both men and women, the consumption of whole grains, potatoes, fruits, vegetables, legumes, and fish increased with higher MTDS, while the consumption of red meat and dairy products decreased (P for trend < 0.05). As MTDS score increased the intake of energy, fiber, vitamins, and minerals (P for trend < 0.05). Men in the highest MTDS tertile had a 41% lower odds ratio (OR) of high psychosocial stress compared with those in the lowest tertile (OR, 0.59; 95% confidence interval [CI], 0.38-0.91). Similarly, women in the highest tertile of the MTDS had a 39% lower OR of high psychosocial stress compared with those in the lowest tertile (OR, 0.61; 95% CI, 0.40-0.95). CONCLUSION Promoting adherence to the Mediterranean diet among baby boomers may have a positive impact on reducing their levels of psychosocial stress.
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Affiliation(s)
- Eun-Hee Jang
- Department of Food and Nutrition, Sungshin Women’s University, Seoul 01133, Korea
| | - Ranmi Jung
- Department of Food and Nutrition, Sungshin Women’s University, Seoul 01133, Korea
| | - Seungmin Lee
- Department of Food and Nutrition, Sungshin Women’s University, Seoul 01133, Korea
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Cao YF, Shi GP, Zhang H, Sun MZ, Wang ZD, Chu XF, Guo JH, Wang XF. Association between Perceived Stress and Motoric Cognitive Risk Syndrome in an Elderly Population: Rugao Longevity and Aging Study. Dement Geriatr Cogn Disord 2024; 53:74-82. [PMID: 38408448 PMCID: PMC11098018 DOI: 10.1159/000537937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024] Open
Abstract
INTRODUCTION Previous studies have indicated a correlation between perceived stress and cognitive decline. However, it remains unknown whether high levels of perceived stress can result in motoric cognitive risk (MCR) syndrome. This study investigated the relationship between perceived stress and MCR in a community-based population. METHODS The study cohort comprised 852 elderly individuals from the Rugao Longitudinal Aging Cohort. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10), while MCR was defined as the coexistence of subjective memory complaints (SMCs) and slow gait speed. RESULTS The average age of the study participants is 79.84 ± 4.34 years. The mean score of PSS-10 among participants is 10.32 (range = 0-33; [SD] = 5.71), with a median score of 10.00 (6.00, 14.00). The prevalence of MCR is 9.3%. In the logistic regression analysis, for each 1-SD (5.71) increase in the global PSS-10 score, the risk of MCR increased by 40% (95% CI 1.09-1.80). Additionally, in the aspect of two components of MCR, with a 1-SD increase (5.71) in the global PSS-10 score, there was a 50% (95% CI 1.29-1.75) increase in the risk of SMCs and a 27% (95% CI 1.04-1.55) increase in the risk of slow gait speed. In terms of specific walking speed, there was a reverse correlation between the global PSS-10 score and walking speed (r = -0.14, p < 0.001). CONCLUSIONS This study provided preliminary evidence that high levels of perceived stress were associated with the risk of MCR in a community-dwelling population.
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Affiliation(s)
- Yuan-Fei Cao
- MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
- Fudan University Rugao Research Institute of Longevity and Aging, Rugao, China
| | - Guo-Ping Shi
- Fudan University Rugao Research Institute of Longevity and Aging, Rugao, China
| | - Hui Zhang
- MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
- Fudan University Rugao Research Institute of Longevity and Aging, Rugao, China
- Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China
| | - Meng-Zhen Sun
- Fudan University Rugao Research Institute of Longevity and Aging, Rugao, China
- Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China
| | - Zheng-Dong Wang
- Fudan University Rugao Research Institute of Longevity and Aging, Rugao, China
| | - Xue-Feng Chu
- Fudan University Rugao Research Institute of Longevity and Aging, Rugao, China
| | - Jiang-Hong Guo
- Fudan University Rugao Research Institute of Longevity and Aging, Rugao, China
| | - Xiao-Feng Wang
- MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
- Fudan University Rugao Research Institute of Longevity and Aging, Rugao, China
- Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Trivedi O, Roy R, Sukumar GM, Philip M, Gururaj G. Levels of work stress among information technology professionals during COVID-19 pandemic in an Indian metropolis. J Family Med Prim Care 2024; 13:674-680. [PMID: 38605784 PMCID: PMC11006029 DOI: 10.4103/jfmpc.jfmpc_1199_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/20/2023] [Accepted: 10/11/2023] [Indexed: 04/13/2024] Open
Abstract
Introduction Amid the ongoing Non-Communicable Disease and COVID-19 pandemic, understanding prevalence and characteristics associated with work stress is vital from a health and economic perspective, more so among information technology (IT) professionals. Objective To estimate the prevalence and factors associated with work stress among IT professionals during the coronavirus disease 2019 (COVID-19) pandemic in Bengaluru, India. Materials and Methods A cross-sectional study was undertaken on a convenient sample of 356 IT professionals in Bengaluru, India, between September 2020 and March 2021 to assess work stress. The weblink to TAWS-16 (Tool to Assess and classify Work Stress) was provided for IT employees to self-report their experience of work-related stressors and coping abilities in the past 6 months. The prevalence and specific prevalence of work stress were calculated. Multi-variate logistic regression was conducted to identify factors associated with work stress. Ethical clearance was obtained from the Institutional Ethics committee, National Institute of Mental Health and Neurosciences, Bengaluru. Informed consent was obtained from study subjects. Results and Conclusion The prevalence of work stress among IT professionals was 17.7% during the COVID19 pandemic, with higher rates among employees aged 31 years and above, among female employees, and among employees with 4-7 years of work experience. More than 80% of the professionals experienced deadline pressures, long working hours, regular multi-tasking, and difficulty in maintaining work-life balance. Based on the results, it is recommended to integrate work-stress assessment in periodical medical examination of IT employees from a health promotion and productivity improvement perspective.
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Affiliation(s)
- Ojaswini Trivedi
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Runalika Roy
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Gautham M. Sukumar
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
| | - Mariamma Philip
- Department of Biostatistics, NIMHANS, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, NIMHANS, Bengaluru, Karnataka, India
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11
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Xiao X, Beach J, Senthilselvan A. Prevalence and determinants of multimorbidity in the Canadian population. PLoS One 2024; 19:e0297221. [PMID: 38289936 PMCID: PMC10826951 DOI: 10.1371/journal.pone.0297221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/01/2024] [Indexed: 02/01/2024] Open
Abstract
Multimorbidity, which is defined as having at least two or more chronic diseases concurrently, has been a rising public health issue in recent years in Canada and worldwide. The increasing prevalence of multimorbidity has posed a burden on the current health care system and quality of life for the Canadian population. There is a lack of up-to-date research on determinants of multimorbidity in the Canadian population, which is necessary to better understand and prevent multimorbidity. This study aims to determine the prevalence and risk factors of multimorbidity in the middle-aged and older Canadian adult population. Multivariable logistic regression analyses incorporating survey weights and biologically plausible interactions were conducted to examine the determinants of multimorbidity using data from the 2017/2018 Canadian Community Health Survey (CCHS). Of the 113,290 CCHS participants, 82,508 subjects who were aged 35 years and above were included in the study. The prevalence of multimorbidity was 22.20% (95% CI: 21.74%, 22.67%) and was greater for females. Multimorbidity was more likely in subjects who were obese, abstaining from alcohol, inactive, had a lower education level, widowed, divorced, or separated and was less likely among subjects living in Quebec. The protective effect of household income on multimorbidity decreased with age. Current smokers who reported extreme stress were more likely to have multimorbidity. Multimorbidity is associated with various determinants that need to be considered in chronic disease control and prevention. These results suggest that future research should focus not only on these determinants but also on the relationships between them. A future longitudinal study is required to provide causal evidence for the study findings.
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Affiliation(s)
- Xiang Xiao
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jeremy Beach
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Aoki J, Zaitsu T, Oshiro A, Aida J. Association of Stressful Life Events With Oral Health Among Japanese Workers. J Epidemiol 2024; 34:16-22. [PMID: 36642514 PMCID: PMC10701250 DOI: 10.2188/jea.je20220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/11/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Psychological stress can cause various mental and physical health problems. The previous results on stress and oral health are inconsistent, possibly because of the narrow stress measurements. We aimed to examine the association between a broader range of stressful life events and oral health among workers. METHODS This cross-sectional study analyzed anonymous individual data from a national survey in Japan. Data on stressful life events, oral health problems which are one or more of tooth pain, gum swelling/bleeding, and difficulty chewing, and covariates were obtained using a self-reported questionnaire. Covariates used included gender, age group, and disease under treatment. Logistic regression analysis was used to estimate the association between stressful life events and oral health problems. We then estimated the causal treatment effects of stress using the augmented inverse-probability weighting (AIPW) method. RESULTS Among the 274,881 subjects, 152,850 men (55.6%) and 122,031 women (44.4%) with a mean age of 47.0 (standard deviation, 14.4) years, 4.0% reported oral health problems, with a prevalence of 2.1% among those without any stress. The prevalence increased with stress score, reaching 15.4% for those with the maximum stress score. The adjusted odds ratio of this group compared to those without any stress was 9.2 (95% confidence interval [CI], 8.2-10.3). The estimated prevalence of oral health problems by the AIPW analysis was 2.2% (95% CI, 2.1-2.3%) for those without any stress and 14.4% (95% CI, 12.1-16.7%) for those with the maximum stress scores. CONCLUSION There was a clear dose-response association between stressful life events and oral health problems.
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Affiliation(s)
- Jin Aoki
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Zaitsu
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akiko Oshiro
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Spencer C, Reed RG, Votruba-Drzal E, Gianaros PJ. Psychological stress and the longitudinal progression of subclinical atherosclerosis. Health Psychol 2024; 43:58-66. [PMID: 37917469 PMCID: PMC10842302 DOI: 10.1037/hea0001333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE In a midlife sample of adults, the present study tested the extent to which changes in psychological stress relate to the progression of subclinical cardiovascular disease over multiple years and explored the potential moderating role of cardiometabolic risk. METHOD Participants were screened to exclude those with clinical cardiovascular, respiratory, metabolic, and other chronic illnesses, as well as those taking psychotropic, cardiovascular, lipid, and glucose control medications. At baseline (N = 331) and then again at follow-up an average of 3 years later (N = 260), participants completed the 10-item Perceived Stress Scale, underwent assessments of their cardiometabolic risk, and underwent ultrasonography to measure carotid artery intima-media thickness (IMT), which is a surrogate indicator of subclinical atherosclerosis. RESULTS Regression models showed that the change in psychological stress from baseline to follow-up was positively associated with the corresponding change in IMT, with covariate control for age at baseline, sex at birth, and variability in length of follow-up across participants. Cardiometabolic risk factors did not statistically moderate this longitudinal association. In exploratory analyses, cardiometabolic risk factors also did not statistically mediate this association. CONCLUSION These longitudinal findings suggest that increases in psychological stress in midlife relate to corresponding increases in subclinical atherosclerosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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OVBIAGELE BRUCE. DECODING STROKE DISPARITIES: ZIP CODES, COLOR CODES, AND EPIGENETIC CODES. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2024; 134:214-227. [PMID: 39135564 PMCID: PMC11316871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Despite decreases in overall stroke incidence and mortality in the United States, racial and ethnic disparities continue unabated. Of note, the long-standing disproportionate burden of stroke on African Americans compared to other racial and ethnic groups persists, and national projections indicate this toll will likely worsen over the next decade. Why have we not been able to bend the stroke disparities curve for African Americans? Well, this is mainly because traditional stroke risk factors, such as hypertension, diabetes, etc., account for just half of the Black vs. non-Hispanic White stroke disparity. As such, there is increasing interest in evaluating understudied factors like upstream social determinants of health, including geography, psychosocial stress, and environmental pollution; identifying potential mediators; and testing multilevel interventions to address them. This paper highlights emerging avenues that may help decode the excess stroke risk in African Americans, focusing on zip codes, color codes, and epigenetic codes.
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Pogosova NV, Ausheva AK, Saner H, Boytsov SA. Stress, Anxiety and Depressive Symptoms are Predictors of Worse Outcomes in Outpatients With Arterial Hypertension and Coronary Heart Disease: Results of 1.5 Years Follow-up From the COMETA Multicenter Study. KARDIOLOGIIA 2023; 63:3-10. [PMID: 38156484 DOI: 10.18087/cardio.2023.12.n2564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/23/2023] [Indexed: 12/30/2023]
Abstract
Aim To study associations between the risk of severe adverse cardiovascular outcomes (SACVO) and all-cause death with psychosocial risk factors (PS RFs), such as stress, anxiety and depressive symptoms, low level of education, low income, social isolation, and type D personality, in patients with arterial hypertension (AH) and ischemic heart disease (IHD) managed in primary health care institutions in a multi-year prospective study.Material and methods PS RFs were assessed in patients with AH or IHD, who participated in a multi-year prospective COMETA study, using the Hospital Anxiety and Depression Scale (HADS), DS-14 questionnaire, and a visual analogue scale (VAS) for assessment of stress level. Associations of PS FRs with SACVO and all-cause death after a 1.5-year follow-up were analyzed using multivariate Cox regression models.Results At 1.5 years after patients were included in the study, it was possible to obtain data for 2,538 patients (age at baseline, 66.6 ± 7.8 years, 28.1% men), 106 of whom died during that period. The incidence of SACVO was 40.0 per 1000 person-years. According to the results of multivariate regression analysis, a very high level of anxiety symptoms (HADS-A≥14) was significantly associated with SACVO (odds ratio (OR), 1.81; 95% confidence interval (CI), 1.04-3.15; p=0. 02). The composite endpoint that included all-cause death and/or SACVO was significantly associated with a high (VAS score ≥8) stress level (OR, 1.53; 95% CI, 1.00-2.33; p=0.04) and a very high (HADS-D≥14) level of depressive symptoms (OR, 2.11; 95% CI, 1.22-3.62; p=0.02). A low level of education adjusted for gender and age increased the likelihood of SACVO by 1.7 (95% CI, 1.19-2.43) times. No significant associations were found between the analyzed outcomes and type D personality or with social isolation.Conclusion In patients with AH or IHD, the presence of high-grade stress and severe depressive symptoms increased the likelihoods of all-cause death and SACVO while a low level of education and severe anxiety symptoms were associated with SACVO. The study results showed that PS RFs for cardiovascular diseases keep the PS RF prognostic significance in the conditions of modern treatment of AH and IHD. Due to the negative impact on the prognosis, PS RFs should be taken into account when taking measures for secondary prevention of AH and IHD.
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Affiliation(s)
- N V Pogosova
- Chazov National Medical Research Center of Cardiology, Moscow; Patrice Lumumba Russian University of Peoples' Friendship, Moscow
| | - A K Ausheva
- Chazov National Medical Research Center of Cardiology, Moscow; Patrice Lumumba Russian University of Peoples' Friendship, Moscow
| | - H Saner
- Institute of Social and Preventive Medicine, Bern
| | - S A Boytsov
- Chazov National Medical Research Center of Cardiology, Moscow
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16
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Chow FC, Mundada NS, Abohashem S, La Joie R, Iaccarino L, Arechiga VM, Swaminathan S, Rabinovici GD, Epel ES, Tawakol A, Hsue PY. Psychological stress is associated with arterial inflammation in people living with treated HIV infection. Brain Behav Immun 2023; 113:21-28. [PMID: 37369339 DOI: 10.1016/j.bbi.2023.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023] Open
Abstract
Stress and depression are increasingly recognized as cerebrovascular risk factors, including among high stress populations such as people living with HIV infection (PLWH). Stress may contribute to stroke risk through activation of neural inflammatory pathways. In this cross-sectional study, we examined the relationships between stress, systemic and arterial inflammation, and metabolic activity in stress-related brain regions on 18F-fluorodeoxyglucose (FDG)-PET in PLWH. Participants were recruited from a parent trial evaluating the impact of alirocumab on radiologic markers of cardiovascular risk in people with treated HIV infection. We administered a stress battery to assess different forms of psychological stress, specifying the Perceived Stress Scale as the primary stress measure, and quantified plasma markers of inflammation and immune activation. Participants underwent FDG-PET of the brain, neck, and chest. Age- and sex-matched control participants without HIV infection were selected for brain FDG-PET comparisons. Among PLWH, we used nonparametric pairwise correlations, partial correlations, and linear regression to investigate the association between stress and 1) systemic inflammation; 2) atherosclerotic inflammation on FDG-PET; and metabolic activity in 3) brain regions in which glucose metabolism differed significantly by HIV serostatus; and 4) in a priori defined stress-responsive regions of interest (ROI) and stress-related neural network activity (i.e., ratio of amygdala to ventromedial prefrontal cortex or temporal lobe activity). We studied 37 PLWH (mean age 60 years, 97% men) and 29 control participants without HIV (mean age 62 years, 97% men). Among PLWH, stress was significantly correlated with systemic inflammation (r = 0.33, p = 0.041) and arterial inflammation in the carotid (r = 0.41, p = 0.023) independent of age, race/ethnicity, traditional vascular risk factors and health-related behaviors. In voxel-wise analyses, metabolic activity in a cluster corresponding to the anterior medial temporal lobes, including the bilateral amygdalae, was significantly lower in PLWH compared with controls. However, we did not find a significant positive relationship between stress and this cluster of decreased metabolic activity in PLWH, a priori defined stress-responsive ROI, or stress-related neural network activity. In conclusion, psychological stress was associated with systemic and carotid arterial inflammation in this group of PLWH with treated infection. These data provide preliminary evidence for a link between psychological stress, inflammation, and atherosclerosis as potential drivers of excess cerebrovascular risk among PLWH.
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Affiliation(s)
- Felicia C Chow
- Departments of Neurology and Medicine (Infectious Diseases) and Weill Institute for Neurosciences, University of California, San Francisco, USA.
| | - Nidhi S Mundada
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Renaud La Joie
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Leonardo Iaccarino
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Victor M Arechiga
- Department of Medicine (Cardiology), University of California, San Francisco, USA
| | - Shreya Swaminathan
- Department of Medicine (Cardiology), University of California, San Francisco, USA
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Elissa S Epel
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Department of Medicine (Cardiology), Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Priscilla Y Hsue
- Department of Medicine (Cardiology), University of California, San Francisco, USA
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17
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Gianola M, Llabre MM, Gallo LC, Daviglus ML, Sotres-Alvarez D, Schneiderman N. Language Preference and its Moderating Role in Coping with Stress: The Hispanic Community Health Study/Study of Latinos. MEDICAL RESEARCH ARCHIVES 2023; 11:10.18103/mra.v11i10.4625. [PMID: 38846550 PMCID: PMC11156427 DOI: 10.18103/mra.v11i10.4625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Stress and stressful events are widely accepted risk factors for cardiometabolic diseases, including coronary heart disease and diabetes. As language plays a seminal role in development and regulation of emotions and appraisals of stressful situations, it may contribute to documented differences in the stress-cardiometabolic disease association across ethnic groups. We investigated associations between language preferences (Spanish vs English) and downstream health consequences of stress. Using data from the Sociocultural Ancillary Study of the Hispanic Community Health Study/Study of Latinos, we assessed the relationship between reported stress and risk factors (alcohol use, smoking, body mass index, depressive symptoms) and prevalence of self-reported (coronary heart disease, stroke, chronic obstructive pulmonary disease [COPD]) and clinically assessed chronic conditions (diabetes, hypertension) among 5154 Hispanic/Latino adults living in the US. Factor analysis was used to calculate a composite stress variable from participants' self-reported chronic stress, perceived stress, and adverse childhood experiences. Sampling weights and survey methodology were integrated in all analyses to account for this study's complex survey design. After controlling for sociodemographic factors (Hispanic/Latino background, study site, years in the US, social acculturation, education, income, age, sex), higher composite stress scores were associated with elevated risk factors and greater prevalence of coronary heart disease, diabetes, and COPD. Furthermore, the relationship between stress and COPD was significantly stronger among Hispanic/Latino adults who preferred to be interviewed in Spanish (compared to English). Stronger connections between stress and likelihood of drinking alcohol among English-preferring persons also emerged. These results are interpreted in light of the Hispanic health paradox and the role of cultural processes in the development of health risk factors and chronic conditions. Our findings can be integrated into relevant approaches to address health disparities within and across Hispanic/Latino populations in the US.
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Münzel T, Sørensen M, Hahad O, Nieuwenhuijsen M, Daiber A. The contribution of the exposome to the burden of cardiovascular disease. Nat Rev Cardiol 2023; 20:651-669. [PMID: 37165157 DOI: 10.1038/s41569-023-00873-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/12/2023]
Abstract
Large epidemiological and health impact assessment studies at the global scale, such as the Global Burden of Disease project, indicate that chronic non-communicable diseases, such as atherosclerosis and diabetes mellitus, caused almost two-thirds of the annual global deaths in 2020. By 2030, 77% of all deaths are expected to be caused by non-communicable diseases. Although this increase is mainly due to the ageing of the general population in Western societies, other reasons include the increasing effects of soil, water, air and noise pollution on health, together with the effects of other environmental risk factors such as climate change, unhealthy city designs (including lack of green spaces), unhealthy lifestyle habits and psychosocial stress. The exposome concept was established in 2005 as a new strategy to study the effect of the environment on health. The exposome describes the harmful biochemical and metabolic changes that occur in our body owing to the totality of different environmental exposures throughout the life course, which ultimately lead to adverse health effects and premature deaths. In this Review, we describe the exposome concept with a focus on environmental physical and chemical exposures and their effects on the burden of cardiovascular disease. We discuss selected exposome studies and highlight the relevance of the exposome concept for future health research as well as preventive medicine. We also discuss the challenges and limitations of exposome studies.
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Affiliation(s)
- Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
| | - Mette Sørensen
- Danish Cancer Society, Copenhagen, Denmark
- Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Omar Hahad
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Mark Nieuwenhuijsen
- Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), PRBB building (Mar Campus), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Andreas Daiber
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
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Trifan G, Gallo LC, Lamar M, Garcia-Bedoya O, Perreira KM, Pirzada A, Talavera GA, Smoller SW, Isasi CR, Cai J, Daviglus ML, Testai FD. Association of Unfavorable Social Determinants of Health With Stroke/Transient Ischemic Attack and Vascular Risk Factors in Hispanic/Latino Adults: Results From Hispanic Community Health Study/Study of Latinos. J Stroke 2023; 25:361-370. [PMID: 37554075 PMCID: PMC10574305 DOI: 10.5853/jos.2023.00626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Social determinants of health (SDOH) are non-medical factors that may contribute to the development of diseases, with a higher representation in underserved populations. Our objective is to determine the association of unfavorable SDOH with self-reported stroke/transient ischemic attack (TIA) and vascular risk factors (VRFs) among Hispanic/Latino adults living in the US. METHODS We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos. SDOH and VRFs were assessed using questionnaires and validated scales and measurements. We investigated the association between the SDOH (individually and as count: ≤1, 2, 3, 4, or ≥5 SDOH), VRFs and stroke/TIA using regression analyses. RESULTS For individuals with stroke/TIA (n=388), the mean age (58.9 years) differed from those without stroke/TIA (n=11,210; 46.8 years; P<0.0001). In bivariate analysis, income <$20,000, education less than high school, no health insurance, perceived discrimination, not currently employed, upper tertile for chronic stress, and lower tertiles for social support and language- and social-based acculturation were associated with stroke/TIA and retained further. A higher number of SDOH was directly associated with all individual VRFs investigated, except for at-risk alcohol, and with number of VRFs (β=0.11, 95% confidence interval [CI]=0.09-0.14). In the fully adjusted model, income, discrimination, social support, chronic stress, and employment status were individually associated with stroke/TIA; the odds of stroke/TIA were 2.3 times higher in individuals with 3 SDOH (95% CI 1.6-3.2) and 2.7 times (95% CI 1.9-3.7) for those with ≥5 versus ≤1 SDOH. CONCLUSION Among Hispanic/Latino adults, a higher number of SDOH is associated with increased odds for stroke/TIA and VRFs. The association remained significant after adjustment for VRFs, suggesting involvement of non-vascular mechanisms.
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Affiliation(s)
- Gabriela Trifan
- Department of Neurology and Rehabilitation, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center and Department of Psychiatry and Behavioral Sciences, Rush University, Chicago, IL, USA
- Department of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Olga Garcia-Bedoya
- Department of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Krista M. Perreira
- Department of Social Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Amber Pirzada
- Department of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Sylvia W. Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jianwen Cai
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Martha L. Daviglus
- Department of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Fernando D. Testai
- Department of Neurology and Rehabilitation, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
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Abstract
Since 2015, stroke has become the leading cause of death and disability in China, posing a significant threat to the health of its citizens as a major chronic non-communicable disease. According to the China Stroke High-risk Population Screening and Intervention Program, an estimated 17.8 million [95% confidence interval (CI) 17.6-18.0 million] adults in China had experienced a stroke in 2020, with 3.4 million (95% CI 3.3-3.5 million) experiencing their first-ever stroke and another 2.3 million (95% CI 2.2-2.4 million) dying as a result. Additionally, approximately 12.5% (95% CI 12.4-12.5%) of stroke survivors were left disabled, as defined by a modified Rankin Scale score greater than 1, equating to 2.2 million (95% CI 2.1-2.2 million) stroke-related disabilities in 2020. As the population ages and the prevalence of risk factors like diabetes, hypertension, and hyperlipidemia continues to rise and remains poorly controlled, the burden of stroke in China is also increasing. A large national epidemiological survey initiated by the China Hypertension League in 2017 showed that the prevalence of hypertension was 24.7%; the awareness, treatment, and control rates in hypertensive patients were: 60.1%, 42.5%, and 25.4%, respectively. A nationally representative sample of the Chinese mainland population showed that the weighted prevalence of total diabetes diagnosed by the American Diabetes Association criteria was 12.8%, suggesting there are 120 million adults with diabetes in China, and the awareness, treatment, and control rates in diabetic patients were: 43.3%, 49.0%, and 49.4%, respectively. The "Sixth National Health Service Statistical Survey Report in 2018" showed that the proportion of the obese population in China was 37.4%, an increase of 7.2 points from 2013. Data from 1599 hospitals in the Hospital Quality Monitoring System and Bigdata Observatory Platform for Stroke of China (BOSC) showed that a total of 3,418,432 stroke cases [mean age ± standard error (SE) was (65.700 ± 0.006) years, and 59.1% were male] were admitted during 2020. Of those, over 80% (81.9%) were ischemic stroke (IS), 14.9% were intracerebral hemorrhage (ICH) strokes, and 3.1% were subarachnoid hemorrhage (SAH) strokes. The mean ± SE of hospitalization expenditures was Chinese Yuan (CNY) (16,975.6 ± 16.3), ranging from (13,310.1 ± 12.8) in IS to (81,369.8 ± 260.7) in SAH, and out-of-pocket expenses were (5788.9 ± 8.6), ranging from (4449.0 ± 6.6) in IS to (30,778.2 ± 156.8) in SAH. It was estimated that the medical cost of hospitalization for stroke in 2020 was CNY 58.0 billion, of which the patient pays approximately CNY 19.8 billion. In-hospital death/discharge against medical advice rate was 9.2% (95% CI 9.2-9.2%), ranging from 6.4% (95% CI 6.4-6.5%) for IS to 21.8% for ICH (95% CI 21.8-21.9%). From 2019 to 2020, the information about 188,648 patients with acute IS receiving intravenous thrombolytic therapy (IVT), 49,845 patients receiving mechanical thrombectomy (MT), and 14,087 patients receiving bridging (IVT + MT) were collected through BOSC. The incidence of intracranial hemorrhage during treatment was 3.2% (95% CI 3.2-3.3%), 7.7% (95% CI 7.5-8.0%), and 12.9% (95% CI 12.3-13.4%), respectively. And in-hospital death/discharge against medical advice rate was 8.9% (95% CI 8.8-9.0%), 16.5% (95% CI 16.2-16.9%), and 16.8% (95% CI 16.2-17.4%), respectively. A prospective nationwide hospital-based study was conducted at 231 stroke base hospitals (Level III) from 31 provinces in China through BOSC from January 2019 to December 2020 and 136,282 stroke patients were included and finished 12-month follow-up. Of those, over 86.9% were IS, 10.8% were ICH strokes, and 2.3% were SAH strokes. The disability rate [% (95% CI)] in survivors of stroke at 3-month and 12-month was 14.8% (95% CI 14.6-15.0%) and 14.0% (95% CI 13.8-14.2%), respectively. The mortality rate [% (95% CI)] of stroke at 3-month and 12-month was 4.2% (95% CI 4.1-4.3%) and 8.5% (95% CI 8.4-8.6%), respectively. The recurrence rate [% (95% CI)] of stroke at 3-month and 12-month was 3.6% (95% CI 3.5-3.7%) and 5.6% (95% CI 5.4-5.7%), respectively. The Healthy China 2030 Stroke Action Plan was launched as part of this review, and the above data provide valuable guidelines for future stroke prevention and treatment efforts in China.
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Affiliation(s)
- Wen-Jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Long-De Wang
- School of Public Health, Peking University, Beijing, 100191, China.
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Burrage EN, Coblentz T, Prabhu SS, Childers R, Bryner RW, Lewis SE, DeVallance E, Kelley EE, Chantler PD. Xanthine oxidase mediates chronic stress-induced cerebrovascular dysfunction and cognitive impairment. J Cereb Blood Flow Metab 2023; 43:905-920. [PMID: 36655326 PMCID: PMC10196752 DOI: 10.1177/0271678x231152551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
Xanthine oxidase (XO) mediates vascular function. Chronic stress impairs cerebrovascular function and increases the risk of stroke and cognitive decline. Our study determined the role of XO on stress-induced cerebrovascular dysfunction and cognitive decline. We measured middle cerebral artery (MCA) function, free radical formation, and working memory in 6-month-old C57BL/6 mice who underwent 8 weeks of control conditions or unpredictable chronic mild stress (UCMS) with or without febuxostat (50 mg/L), a XO inhibitor. UCMS mice had an impaired MCA dilation to acetylcholine vs. controls (p < 0.0001), and increased total free radical formation, XOR protein levels, and hydrogen peroxide production in the liver compared to controls. UCMS increased hydrogen peroxide production in the brain and cerebrovasculature compared to controls. Working memory, using the y-maze test, was impaired (p < 0.05) in UCMS mice compared to control mice. However, blocking XO using febuxostat prevented the UCMS-induced impaired MCA response, while free radical production and hydrogen peroxide levels were similar to controls in the liver and brain of UCMS mice treated with febuxostat. Further, UCMS + Feb mice did not have a significant reduction in working memory. These data suggest that the cerebrovascular dysfunction associated with chronic stress may be driven by XO, which leads to a reduction in working memory.
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Affiliation(s)
- Emily N Burrage
- Department of Neuroscience, West
Virginia University School of Medicine, Morgantown, WV, USA
| | - Tyler Coblentz
- Division of Exercise Physiology,
West Virginia University School of Medicine, Morgantown, WV, USA
| | - Saina S Prabhu
- Department of Pharmaceutical
Sciences, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Ryan Childers
- Division of Exercise Physiology,
West Virginia University School of Medicine, Morgantown, WV, USA
| | - Randy W Bryner
- Division of Exercise Physiology,
West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sarah E Lewis
- Department of Physiology and
Pharmacology, West Virginia University School of Medicine, Morgantown, WV,
USA
| | - Evan DeVallance
- Department of Physiology and
Pharmacology, West Virginia University School of Medicine, Morgantown, WV,
USA
| | - Eric E Kelley
- Department of Physiology and
Pharmacology, West Virginia University School of Medicine, Morgantown, WV,
USA
| | - Paul D Chantler
- Department of Neuroscience, West
Virginia University School of Medicine, Morgantown, WV, USA
- Division of Exercise Physiology,
West Virginia University School of Medicine, Morgantown, WV, USA
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22
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Tinsel I, Schmoor C, Börger M, Kamp M, Kaier K, Hardt H, Kloppe T, Rakebrandt A, Scherer M, Bergmann A, Görbing T, Kutter S, Riemenschneider H, Maun A. Encouragement of patients' self-management in primary care for the prevention of cardiovascular diseases (DECADE): protocol for a cluster randomised controlled trial. BMJ Open 2023; 13:e071230. [PMID: 37185187 PMCID: PMC10151245 DOI: 10.1136/bmjopen-2022-071230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Cardiovascular diseases are the most common cause of death in Germany and among the most frequent reasons for encounters in primary care. Most patients with cardiovascular risks (CVRs) have difficulties implementing health-promoting behavioural changes. In this study, a complex intervention containing evidence-based patient materials and structured follow-up consultations are intended to strengthen patients' self-management to improve health behaviour. METHODS AND ANALYSIS In this cluster randomised controlled trial, we investigate the effects of the intervention "Decision aid, action planning and follow-up support for patients to reduce the 10-year risk of cardiovascular diseases" (DECADE) using a 2×2 design. All patients, including the control group (CG), receive a CVR calculation. Three intervention groups (IGs) receive one or both of two different components of the DECADE intervention: IG1 (patient materials), IG2 (follow-up consultations) and IG3 (patient materials and follow-up consultations). The study was planned to be conducted with 77 general practitioners in 3 German regions and a target sample size of 924 patients. The observation period for each patient amounts to 12 months with three patient surveys: baseline (t0), after 6 and 12 months (t1 and t2). The primary outcome is patient activation (Patient Activation Measure 13 (PAM13-D)) at t1. Secondary outcomes include PAM13-D at t2 and further patient-reported and clinical outcomes at t1 and t2. We will also analyse the cost-effectiveness of the intervention, the degree of usage and satisfaction with the intervention. ETHICS AND DISSEMINATION The study was first approved by the lead ethics committee of the University of Freiburg on 15 April 2021 (vote number: 21-1078) and subsequently by the other ethics committees in the study regions (Ethics committee of medical association Baden-Württemberg (B-F-2021-078), Ethics Committee of the Technische Universität Dresden, Dresden (BO-EK-251052021), Ethics Committee of the State Chamber of Physicians of Saxony (EK-BR-92/21-1), Ethics Committee of the Hamburg Medical Association (2021-200013-BO-bet)). Informed consent is required for patients to participate in the study. The results of this study will be published in peer-reviewed journals and presented at congresses by the DECADE team. The DECADE lead management will communicate the results to the funder of this study. TRIAL REGISTRATION NUMBER German Clinical Trials Register, DRKS00025401 (registration date: 21 June 2021); International Clinical Trials Registry Platform, DRKS00025401.
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Affiliation(s)
- Iris Tinsel
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Maja Börger
- Institute of General Practice/Family Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Melanie Kamp
- Institute of General Practice/Family Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Hanna Hardt
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Kloppe
- Department of General Practice and Primary Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rakebrandt
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antje Bergmann
- Department of General Practice, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tina Görbing
- Department of General Practice, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Susanne Kutter
- Department of General Practice, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Henna Riemenschneider
- Department of General Practice, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andy Maun
- Institute of General Practice/Family Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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23
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Chiangkhong A, Suwanwong C, Wongrostrai Y. Lifestyle, clinical, and occupational risk factors of recurrent stroke among the working-age group: A systematic review and meta-analysis. Heliyon 2023; 9:e13949. [PMID: 36915512 PMCID: PMC10006477 DOI: 10.1016/j.heliyon.2023.e13949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
Background Stroke recurrence is increasing in the working-age population. This study aimed to summarize and evaluate the risk factors for recurrent stroke among the working-age population. Methods Relevant studies were extracted from several databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Fixed- or random-effects estimates of the pooled odds ratio (OR) and 95% confidence interval (CI) of risk factors for recurrent stroke were generated based on heterogeneity. Subgroup and publication bias analyses were also performed. Results Seventeen studies were included in the meta-analysis. Pooled effects results revealed that the risk of recurrent stroke in the working-age group was as follows: Diabetes (OR = 1.85, 95% CI: 1.47, 2.32), hypertension (OR = 1.27, 95% CI: 1.12, 1.44), smoking (OR = 1.52, 95% CI: 1.27, 1.81), history of cardiac disease (OR = 2.86, 95% CI: 2.22, 3.67), history of stroke (OR = 2.45, 95% CI: 1.81, 3.31), and National Institutes of Health stroke severity score (OR = 1.09, 95% CI: 1.03, 1.15). Conclusion These findings suggest that several factors, such as diabetes, hypertension, smoking, history of cardiac disease and stroke, and severity of a stroke, are potential risk factors for recurrent stroke in the working-age group. Therefore, strategies to reduce those risk factors should be adopted and attention paid to prevent recurrent stroke among working-age populations.
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Affiliation(s)
- Araya Chiangkhong
- Kuakarun Faculty of Nursing, Navamindradhiraj University, Bangkok, Thailand
| | - Charin Suwanwong
- Behavioral Science Research Institute, Srinakharinwirot University, Bangkok, Thailand
| | - Yupha Wongrostrai
- Kuakarun Faculty of Nursing, Navamindradhiraj University, Bangkok, Thailand
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24
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Arpawong TE, Sakuma KLK, Espinoza L, Huh J. Longitudinal Examination of an Ethnic Paradox of Stress and Mental Health in Older Black and Latinx Adults. Clin Gerontol 2023; 46:27-46. [PMID: 35320059 PMCID: PMC9500116 DOI: 10.1080/07317115.2022.2056102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To explain the ethnic paradox of mental health in aging, we evaluated whether Black and Latinx older adults experience (1) fewer depressive symptoms (DepSx), but more physical problems, and (2) greater psychological resilience as a result of life stressors than White older adults. METHODS DepSx, physical health, and recent stress were obtained biennially from 25,893 older adults (77% White, 15% Black, 9% Latinx) in the U.S. Health and Retirement Study, across 16 years. Psychological resilience, lifetime stress, and discrimination experiences were available for 13,655 individuals. We conducted mixed-effects and linear regression analyses. RESULTS For Blacks and Latinxs, experiencing more-than-usual stress events was associated with less increase in DepSx compared to Whites, although on average Blacks and Latinxs experience more DepSx. Black adults showed worse physical health than White adults and weaker effects of stress on psychological resilience despite experiencing more stress of all types. Findings were mixed for Latinxs. CONCLUSIONS Studying effects of time-varying stress on changes in health and multiple stressors on psychological resilience by race/ethnicity elucidates mechanisms for later-age health disparities. CLINICAL IMPLICATIONS Cross-sectional evaluations of stress and psychological health in a clinical setting may provide incomplete appraisals of health risks for Black and Latinx older Americans.
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Affiliation(s)
- Thalida Em Arpawong
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Kari-Lyn K. Sakuma
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Lilia Espinoza
- Department of Public Health, California State University, Fullerton, CA, USA
| | - Jimi Huh
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
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25
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Maalouf E, Hallit S, Salameh P, Hosseini H. Depression, anxiety, insomnia, stress, and the way of coping emotions as risk factors for ischemic stroke and their influence on stroke severity: A case-control study in Lebanon. Front Psychiatry 2023; 14:1097873. [PMID: 36896347 PMCID: PMC9988919 DOI: 10.3389/fpsyt.2023.1097873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Stroke is a leading cause of disability and death worldwide. There are numerous debates regarding the relationship between depression, anxiety, insomnia, perceived stress, and ischemic stroke. Moreover, no research on the efficacy of emotion regulation, which is critical for various components of healthy affective and social adaptability, is being conducted. To the best of our knowledge, this is the first study in the MENA region to shed light on the relationship between these conditions and stroke risk, aiming to determine whether depression, anxiety, insomnia, stress, and the way of coping with emotions may be risk factors for ischemic stroke occurrence and to further investigate the ability of two specific types of emotion regulation (cognitive reappraisal and expressive suppression) as possible moderators of the relationship between these psychological diseases and ischemic stroke risk. As a secondary objective, we sought to determine how these pre-existing conditions affect stroke severity levels. METHODS This is a case-control survey study involving 113 Lebanese inpatients with a clinical diagnosis of ischemic stroke admitted in hospitals and rehabilitation centers in Beirut and Mount Lebanon, and 451 gender-matched volunteers without clinical signs of stroke as controls recruited from the same hospitals as the cases or attending outpatient clinics for illnesses or treatments unconnected to stroke or transient ischemic attack, as well as visitors or relatives of inpatients (April 2020-April 2021). Data was collected by filling out an anonymous paper-based questionnaire. RESULTS According to the outcomes of the regression model, depression (aOR: 1.232, 95%CI: 1.008-1.506), perceived stress (aOR: 1.690, 95%CI: 1.413-2.022), a lower educational level (aOR: 0.335, 95%CI: 0.011-10.579), and being married (aOR: 3.862, 95%CI: 1.509-9.888) were associated with an increased risk of ischemic stroke. The moderation analysis revealed that expressive suppression had a significant moderating effect on the relationship between depression, anxiety, perceived stress, insomnia, and ischemic stroke risk, resulting in an increased risk of stroke incidence. In contrast, cognitive reappraisal significantly reduced the risk of ischemic stroke by moderating the association between ischemic stroke risk and the following independent variables: perceived stress and insomnia. On the other hand, our multinomial regression model revealed that the odds of moderate to severe/severe stroke were significantly higher in people with pre-stroke depression (aOR: 1.088, 95% CI: 0.747-1.586) and perceived stress (aOR: 2.564, 95% CI: 1.604-4.100) compared to people who had never had a stroke. CONCLUSION Despite several limitations, the findings of our study suggest that people who are depressed or stressed are more likely to have an ischemic stroke. Consequently, additional research into the causes and effects of depression and perceived stress may provide new directions for preventive strategies that can help reduce the risk of stroke. Since pre-stroke depression and perceived stress were also found to be strongly correlated with stroke severity, future studies should evaluate the association between pre-stroke depression, perceived stress, and stroke severity to gain a deeper understanding of the complex interaction between these variables. Lastly, the study shed new light on the role of emotion regulation in the relationship between depression, anxiety, perceived stress, insomnia, and ischemic stroke.
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Affiliation(s)
- Elise Maalouf
- Life and Health Sciences Department, Paris-Est University, Paris, France
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.,Applied Science Research Center, Applied Science Private University, Amman, Jordan.,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, Lebanon.,INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicolo-gie-Liban, Beirut, Lebanon.,Medical School, University of Nicosia, Nicosia, Cyprus.,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Hassan Hosseini
- Faculté de Santé, UPE-C, Université Paris-Est Créteil, Créteil, France.,Hopital Henri Mondor, APHP, Créteil, France
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26
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de Vries HJ, Pennings HJM, van der Schans CP, Sanderman R, Oldenhuis HKE, Kamphuis W. Wearable-Measured Sleep and Resting Heart Rate Variability as an Outcome of and Predictor for Subjective Stress Measures: A Multiple N-of-1 Observational Study. SENSORS (BASEL, SWITZERLAND) 2022; 23:s23010332. [PMID: 36616929 PMCID: PMC9823534 DOI: 10.3390/s23010332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 05/27/2023]
Abstract
The effects of stress may be alleviated when its impact or a decreased stress-resilience are detected early. This study explores whether wearable-measured sleep and resting HRV in police officers can be predicted by stress-related Ecological Momentary Assessment (EMA) measures in preceding days and predict stress-related EMA outcomes in subsequent days. Eight police officers used an Oura ring to collect daily Total Sleep Time (TST) and resting Heart Rate Variability (HRV) and an EMA app for measuring demands, stress, mental exhaustion, and vigor during 15-55 weeks. Vector Autoregression (VAR) models were created and complemented by Granger causation tests and Impulse Response Function visualizations. Demands negatively predicted TST and HRV in one participant. TST negatively predicted demands, stress, and mental exhaustion in two, three, and five participants, respectively, and positively predicted vigor in five participants. HRV negatively predicted demands in two participants, and stress and mental exhaustion in one participant. Changes in HRV lasted longer than those in TST. Bidirectional associations of TST and resting HRV with stress-related outcomes were observed at a weak-to-moderate strength, but not consistently across participants. TST and resting HRV are more consistent predictors of stress-resilience in upcoming days than indicators of stress-related measures in prior days.
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Affiliation(s)
- Herman J. de Vries
- Research Group Digital Transformation, Hanze University of Applied Sciences, 9747 AS Groningen, The Netherlands
- Department of Human Behaviour & Training, Netherlands Organization for Applied Scientific Research (TNO), 3769 DE Soesterberg, The Netherlands
- Department of Health Psychology, University Medical Center Groningen, 9700 AB Groningen, The Netherlands
| | - Helena J. M. Pennings
- Department of Human Behaviour & Training, Netherlands Organization for Applied Scientific Research (TNO), 3769 DE Soesterberg, The Netherlands
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Cees P. van der Schans
- Department of Rehabilitation Medicine, University Medical Center Groningen, 9700 AB Groningen, The Netherlands
- Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, 9747 AS Groningen, The Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, 9700 AB Groningen, The Netherlands
- Department of Psychology, Health and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Hilbrand K. E. Oldenhuis
- Research Group Digital Transformation, Hanze University of Applied Sciences, 9747 AS Groningen, The Netherlands
| | - Wim Kamphuis
- Department of Human Behaviour & Training, Netherlands Organization for Applied Scientific Research (TNO), 3769 DE Soesterberg, The Netherlands
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27
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Reddin C, Murphy R, Hankey GJ, Judge C, Xavier D, Rosengren A, Ferguson J, Alvarez-Iglesias A, Oveisgharan S, Iversen HK, Lanas F, Al-Hussein F, Członkowska A, Oguz A, McDermott C, Pogosova N, Málaga G, Langhorne P, Wang X, Wasay M, Yusuf S, O’Donnell M. Association of Psychosocial Stress With Risk of Acute Stroke. JAMA Netw Open 2022; 5:e2244836. [PMID: 36484991 PMCID: PMC9856236 DOI: 10.1001/jamanetworkopen.2022.44836] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Psychosocial stress is considered a modifiable risk factor for stroke. Given the prevalence of chronic and acute exposure to stress, it represents a potentially attractive target for population-health interventions. OBJECTIVES To determine the association of psychosocial stress with the risk of acute stroke and explore factors that might modify the association of stress with risk of acute stroke in a large international population. DESIGN, SETTING, AND PARTICIPANTS INTERSTROKE is an international retrospective case-control study of risk factors for first acute stroke in 32 countries in Asia, North and South America, Europe, Australia, the Middle East, and Africa. A total of 13 462 patients with stroke and 13 488 matched controls were recruited between January 11, 2007, and August 8, 2015. The present analyses were performed from June 1 to 30, 2021, and included 13 350 cases and 13 462 controls with available data on psychosocial stress. EXPOSURES Psychosocial stress and occurrence of stressful life events within the preceding year were measured using a standardized questionnaire of self-reported stress at home and work. MAIN OUTCOMES AND MEASURES The association of stress with acute stroke and its subtypes was examined using multivariable conditional logistic regression and factors that might modify the association, particularly self-reported locus of control. RESULTS Among 26 812 participants included in the analysis, the mean (SD) age of cases was 62.2 (13.6) years; that of controls, 61.3 (13.3) years; 7960 cases (59.6%) and 8017 controls (59.6%) were men. Several periods of stress and permanent stress were reported for 2745 cases (20.5%) and 1933 controls (14.4%), with marked regional variation in prevalence, with the lowest in China (201 of 3981 [5.0%] among controls and 364 of 3980 [9.1%] among cases) and highest in South East Asia (233 of 855 [26.1%] among controls and 241 of 782 [30.8%] among cases). Increased stress at home (odds ratio [OR], 1.95 [95% CI, 1.77-2.15]) and at work (OR, 2.70 [95% CI, 2.25-3.23]) and recent stressful life events (OR, 1.31 [95% CI, 1.19-1.43]) were associated with an increased risk of acute stroke on multivariable analyses (vs no self-reported stress). Higher locus of control at home was associated with a reduced odds of all stroke (OR, 0.73 [95% CI, 0.68-0.79]), and higher locus of control both at work and at home were associated with a lower odds of acute stroke and significantly diminished the association with stress at work (OR, 2.20 [95% CI, 1.88-2.58]; P = .008 for interaction) and home (OR, 1.69 [95% CI, 1.44-1.98]; P < .001 for interaction) for acute stroke. CONCLUSIONS AND RELEVANCE Psychosocial stress is a common risk factor for acute stroke. The findings of this case-control study suggest that higher locus of control is associated with lower risk of stroke and may be an important effect modifier of the risk associated with psychosocial stress.
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Affiliation(s)
- Catriona Reddin
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
- Wellcome Trust–HRB, Irish Clinical Academic Training, Dublin, Ireland
| | - Robert Murphy
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Graeme J. Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Conor Judge
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
- Wellcome Trust–HRB, Irish Clinical Academic Training, Dublin, Ireland
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Denis Xavier
- Division of Clinical Research and Training, St Johns Medical College and Research Institute, Bangalore, India
| | - Annika Rosengren
- Cardiology Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Ferguson
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Alberto Alvarez-Iglesias
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Shahram Oveisgharan
- Rush Alzheimer Disease Research Center, Rush University Medical Center, Chicago, Illinois
| | - Helle K. Iversen
- Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Lanas
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Fawaz Al-Hussein
- Department of Neurology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Dumlupinar Mahallesi, Istanbul, Turkey
| | - Clodagh McDermott
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia
| | - German Málaga
- Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Peter Langhorne
- Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
| | - Xingyu Wang
- Beijing Hypertension League Institute, Beijing, China
| | - Mohammad Wasay
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Martin O’Donnell
- HRB (Health Research Board) Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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28
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Kızıltepe R, Korkmaz M, Yılmaz Irmak T. Exposure to Recurring Community Violence Scale: A validity and reliability study in Turkey. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3371-3386. [PMID: 35301721 DOI: 10.1002/jcop.22841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/16/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
Recent years have witnessed a substantial increase in the interest in violence occurring at home or school, as well as in neighborhoods. Yet, there is no standardized instrument to measure community violence in Turkey. Thus, the present study aimed to adapt the Exposure to Recurring Community Violence Scale into Turkish and explore its psychometric properties. The sample consisted of 210 participants (57% were females) between 18 and 64 years (Mage = 38.33, SD = 10.67). For criterion-related validity, we evaluated the participants' scores on the Brief Symptom Inventory (BSI), the Traumatic Life Events Form, the Relationship Quality Scale, and a Demographic Information Form. We performed all statistical analyses using the FACTOR and SPSS v.20 programs. Exploratory factor analysis revealed a 2-factor structure for the scale (victimization and witnessing), explaining 52% of the total variance. As expected, the witnessing and victimization scores were correlated with the subscales of the BSI, the number of traumatic life events, and the subscales of The Relationship Quality Scale. For reliability concerns, we calculated Cronbach's α coefficients to be 0.79 for the victimization and 0.90 for the witnessing. Besides, the findings revealed acceptable psychometric properties for the Turkish version of the Exposure to Recurring Community Violence Scale. Thereby, we concluded that the scale can be used as a reliable and valid measure in the Turkish context. Overall, the scale will likely allow further research to scrutinize the risk factors and consequences of community violence.
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Love MF, Brooks AN, Cox SD, Okpala M, Cooksey G, Cohen AS, Sharrief AZ. The effects of racism and resilience on Black stroke- survivor quality of life: Study protocol and rationale for a mixed-methods approach. Front Neurol 2022; 13:885374. [PMID: 36034272 PMCID: PMC9399920 DOI: 10.3389/fneur.2022.885374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Stroke, a life-threatening stressor, often negatively impacts stroke-survivor (SS) quality of life (QoL). Annual age-adjusted incidence and death rates for stroke are significantly higher among Black Americans than among White Americans. Racism, a significant stressor, occurs at structural, cultural, and interpersonal levels and contributes to health disparities for Black SS. Resilience, a dynamic process of positive adaptation to significant stress, is impacted by factors or resources both internal and external to the individual. This study aims to examine the effects of experiences of racism and resilience on Black SS QoL during early stroke recovery. This article presents the study protocol. Methods and analyses This will be a prospective observational mixed-methods study. Black community-dwelling adults who are within 4 weeks of a stroke will be eligible for inclusion. Baseline measures will include the exposure variables of experiences of racism and resilience. Covariates measured at baseline include sociodemographic variables (age, sex, marital status, education, income, health insurance, employment status, number of people in household, residential address), clinical variables (date and type of stroke, inferred Modified Rankin Scale, anxiety and depression screening), and psychosocial variables (COVID-19 stress, perceived stress, mindfulness). The outcome variable (QoL) will be assessed 6-months post-stroke. Multiple-level linear regression models will be used to test the direct effects of experiences of racism, and the direct and indirect effects of resilience, on QoL. Qualitative data will be collected via focus groups and analyzed for themes of racism, resilience, and QoL. Discussion Racism can compound the stress exerted by stroke on Black SS. This study will occur during the COVID-19 pandemic and in the aftermath of calls for social justice for Black Americans. Experiences of racism will be measured with instruments for both “everyday” discrimination and vigilance. Sociodemographic variables will be operationalized to assess specific social determinants of health that intersect with structural racism. Because of the long-standing history of racism in the United States of America (USA), cultural influences and access to resources are central to the consideration of individual-level resilience in Black SS. Study results may inform the development of interventions to support Black SS QoL through enhanced resilience.
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Affiliation(s)
- Mary F. Love
- College of Nursing, University of Houston, Houston, TX, United States
- *Correspondence: Mary F. Love
| | | | - Sonya D. Cox
- College of Nursing, University of Houston, Houston, TX, United States
| | - Munachi Okpala
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Gail Cooksey
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Audrey Sarah Cohen
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Anjail Z. Sharrief
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
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Kuusi T, Viertiö S, Helenius A, Tervo-Niemelä K. Health and Well-Being of Church Musicians during the COVID-19 Pandemic-Experiences of Health and Work-Related Distress from Musicians of the Evangelical Lutheran Church in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9866. [PMID: 36011497 PMCID: PMC9407782 DOI: 10.3390/ijerph19169866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Earlier research has revealed contrasting gender results in standardized mortality ratios (SMR) for cancers and cardiovascular diseases of Finnish church musicians compared with the general population. In order to better understand the SMRs, our study examined gender differences in health and work-related experiences of church musicians with special focus on experienced stress and burnout on the one hand, and work engagement and mental well-being on the other. The data were collected by a questionnaire including both standardized measures and open-ended questions. Statistical methods (mostly χ2 tests) were used for examining gender differences in the measures, and the open-ended questions were analyzed using theory-driven content analysis. The two sets of data complemented each other. Analyses of the standardized measures showed that church musicians have more burnout and distress than the general population but the results were not gendered. However, the open-ended questions revealed clearly higher distress in females than in males. Based on the contrast between the measures and the open-ended questions, we raise the question about how well females who have distressing work can recognize the stress factors and change them, especially if distress becomes a "normal state".
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Affiliation(s)
- Tuire Kuusi
- Sibelius Academy, Uniarts Helsinki, 00100 Helsinki, Finland
| | - Satu Viertiö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare in Finland (THL), 00271 Helsinki, Finland
| | - Anna Helenius
- Sibelius Academy, Uniarts Helsinki, 00100 Helsinki, Finland
| | - Kati Tervo-Niemelä
- Faculty of Philosophy, Department of Theology, University of Eastern Finland, 70211 Kuopio, Finland
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Kell PA, Huber FA, Street EN, Shadlow JO, Rhudy JL. Sleep Problems Mediate the Relationship Between Psychosocial Stress and Pain Facilitation in Native Americans: A Structural Equation Modeling Analysis from the Oklahoma Study of Native American Pain Risk. Ann Behav Med 2022; 56:1116-1130. [PMID: 35775809 PMCID: PMC9924047 DOI: 10.1093/abm/kaac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Native Americans (NAs) are more likely to experience chronic pain than non-Hispanic Whites (NHWs); however, the proximate causes predisposing NAs to chronic pain remain elusive. Likely due to centuries of adversity, discrimination, and marginalization, NAs report greater psychological stress than NHWs, which may place them at risk for sleep problems, a well-established risk factor for chronic pain onset. PURPOSE This study examined the effects of psychological stress and sleep problems on subjective and physiological measures of pain processing in NAs and NHWs. METHODS Structural equation modeling was used to determine whether ethnicity (NA or NHW) was associated with psychological stress or sleep problems and whether these variables were related to conditioned pain modulation of pain perception (CPM-pain) and the nociceptive flexion reflex (CPM-NFR), temporal summation of pain (TS-pain) and NFR (TS-NFR), and pain tolerance in a sample of 302 (153 NAs) pain-free participants. RESULTS NAs experienced more psychological stress (Estimate = 0.027, p = .009) and sleep problems (Estimate = 1.375, p = .015) than NHWs. When controlling for age, sex, physical activity, BMI, and general health, NA ethnicity was no longer related to greater sleep problems. Psychological stress was also related to sleep problems (Estimate = 30.173, p = <.001) and psychological stress promoted sleep problems in NAs (indirect effect = 0.802, p = .014). In turn, sleep problems were associated with greater TS-pain (Estimate = 0.714, p = .004), but not other pain measures. CONCLUSIONS Sleep problems may contribute to chronic pain risk by facilitating pain perception without affecting facilitation of spinal neurons or endogenous inhibition of nociceptive processes. Since psychological stress promoted pain facilitation via enhanced sleep problems, efforts to reduce psychological stress and sleep problems among NAs may improve health outcomes.
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Affiliation(s)
- Parker A Kell
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | | | - Erin N Street
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
| | - Joanna O Shadlow
- Department of Psychology, The University of Tulsa, Tulsa, OK, USA
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Bayo Jimenez MT, Frenis K, Hahad O, Steven S, Cohen G, Cuadrado A, Münzel T, Daiber A. Protective actions of nuclear factor erythroid 2-related factor 2 (NRF2) and downstream pathways against environmental stressors. Free Radic Biol Med 2022; 187:72-91. [PMID: 35613665 DOI: 10.1016/j.freeradbiomed.2022.05.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/23/2022] [Accepted: 05/19/2022] [Indexed: 12/14/2022]
Abstract
Environmental risk factors, including noise, air pollution, chemical agents, ultraviolet radiation (UVR) and mental stress have a considerable impact on human health. Oxidative stress and inflammation are key players in molecular pathomechanisms of environmental pollution and risk factors. In this review, we delineate the impact of environmental risk factors and the protective actions of the nuclear factor erythroid 2-related factor 2 (NRF2) in connection to oxidative stress and inflammation. We focus on well-established studies that demonstrate the protective actions of NRF2 and its downstream pathways against different environmental stressors. State-of-the-art mechanistic considerations on NRF2 signaling are discussed in detail, e.g. classical concepts like KEAP1 oxidation/electrophilic modification, NRF2 ubiquitination and degradation. Specific focus is also laid on NRF2-dependent heme oxygenase-1 induction with detailed presentation of the protective down-stream pathways of heme oxygenase-1, including interaction with BACH1 system. The significant impact of all environmental stressors on the circadian rhythm and the interactions of NRF2 with the circadian clock will also be considered here. A broad range of NRF2 activators is discussed in relation to environmental stressor-induced health side effects, thereby suggesting promising new mitigation strategies (e.g. by nutraceuticals) to fight the negative effects of the environment on our health.
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Affiliation(s)
- Maria Teresa Bayo Jimenez
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Katie Frenis
- Department of Hematology and Oncology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Omar Hahad
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany; Leibniz Insitute for Resilience Research (LIR), Mainz, Germany
| | - Sebastian Steven
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Guy Cohen
- The Skin Research Institute, The Dead Sea and Arava Science Center, Masada, 86910, Israel; Ben Gurion University of the Negev, Eilat Campus, Eilat, 8855630, Israel
| | - Antonio Cuadrado
- Departamento de Bioquímica, Facultad de Medicina, Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Investigación Sanitaria La Paz (IdiPaz), Instituto de Investigaciones Biomédicas 'Alberto Sols' UAM-CSIC, Universidad Autónoma de Madrid, Madrid, Spain
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
| | - Andreas Daiber
- Department of Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, 55131, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
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Burin D, Cavanna G, Rabellino D, Kotozaki Y, Kawashima R. Neuroendocrine Response and State Anxiety Due to Psychosocial Stress Decrease after a Training with Subject's Own (but Not Another) Virtual Body: An RCT Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106340. [PMID: 35627877 PMCID: PMC9140346 DOI: 10.3390/ijerph19106340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023]
Abstract
Previous research involving healthy participants has reported that seeing a moving virtual body from the first person perspective induces the illusion of ownership and agency over that virtual body. When a person is sitting and the virtual body runs, it is possible to measure physiological, behavioral and cognitive reactions that are comparable to those that occur during actual movement. Capitalizing on this evidence, we hypothesized that virtual training could also induce neuroendocrine effects that prompt a decreased psychosocial stress response, as occurs after physical training. While sitting, 26 healthy young adults watched a virtual avatar running for 30 min from the first person perspective (experimental group), while another 26 participants watched the virtual body from the third person perspective (control group). We found a decreased salivary alpha-amylase concentration (a biomarker for the stress response) after the virtual training among the experimental group only, as well as a decreased subjective feeling of state anxiety (but no difference in heart rate). We argue that the virtual illusion of a moving body from the first person perspective can initiate a cascade of events, from the perception of the visual illusion to physiological activation that triggers other biological effects, such as the neuroendocrine stress response.
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Affiliation(s)
- Dalila Burin
- Institute of Development, Aging and Cancer (IDAC), Tohoku University, 4-1 Seiryocho, Aobaku, Sendai 980-8575, Japan;
- Smart Aging Research Center (SARC), Tohoku University, 4-1 Seiryocho, Aobaku, Sendai 980-8575, Japan;
- Correspondence: ; Tel.: +81-022-717-8585
| | - Gabriele Cavanna
- Smart Aging Research Center (SARC), Tohoku University, 4-1 Seiryocho, Aobaku, Sendai 980-8575, Japan;
- Graduate School of Science, Tohoku University, 6-3 Aramaki Aza-Aoba, Aobaku, Sendai 980-8578, Japan
| | - Daniela Rabellino
- Department of Psychiatry, Western University, 550 Wellington Rd., London, ON N6C 5J1, Canada;
| | - Yuka Kotozaki
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1, Idaidori, Yahaba, Iwate, Morioka 028-3694, Japan;
| | - Ryuta Kawashima
- Institute of Development, Aging and Cancer (IDAC), Tohoku University, 4-1 Seiryocho, Aobaku, Sendai 980-8575, Japan;
- Smart Aging Research Center (SARC), Tohoku University, 4-1 Seiryocho, Aobaku, Sendai 980-8575, Japan;
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Cattaneo M, Halasz G, Cattaneo MM, Younes A, Gallino C, Sudano I, Gallino A. The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina. Front Cardiovasc Med 2022; 9:896042. [PMID: 35647077 PMCID: PMC9136057 DOI: 10.3389/fcvm.2022.896042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/14/2022] [Indexed: 01/09/2023] Open
Abstract
Patients diagnosed with ischemia without obstructive coronary artery disease (INOCA) comprise the group of patients with primary microvascular angina (MVA). The pathophysiology underlying ischemia and angina is multifaceted. Differences in vascular tone, collateralization, environmental and psychosocial factors, pain thresholds, and cardiac innervation seem to contribute to clinical manifestations. There is evidence suggesting potential interactions between the clinical manifestations of MVA and non-cardiac conditions such as abnormal function of the central autonomic network (CAN) in the central nervous system (CNS), pain modulation pathways, and psychological, psychiatric, and social conditions. A few unconventional non-pharmacological and pharmacological techniques targeting these psychosocial conditions and modulating the CNS pathways have been proposed to improve symptoms and quality of life. Most of these unconventional approaches have shown encouraging results. However, these results are overall characterized by low levels of evidence both in observational studies and interventional trials. Awareness of the importance of microvascular dysfunction and MVA is gradually growing in the scientific community. Nonetheless, therapeutic success remains frustratingly low in clinical practice so far. This should promote basic and clinical research in this relevant cardiovascular field investigating, both pharmacological and non-pharmacological interventions. Standardization of definitions, clear pathophysiological-directed inclusion criteria, crossover design, adequate sample size, and mid-term follow-up through multicenter randomized trials are mandatory for future study in this field.
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Affiliation(s)
- Mattia Cattaneo
- Cardiology Department, Istituto Cardiocentro Ticino, Lugano, Switzerland
- Human Medicine Department, Università della Svizzera italiana, Lugano, Switzerland
- Cardiovascular Research Unit, Hospital of San Giovanni, Bellinzona, Switzerland
- *Correspondence: Mattia Cattaneo ;
| | - Geza Halasz
- Heart Failure Unit, Guglielmo da Saliceto Hospital, Azienda unità sanitaria locale (AUSL) Piacenza, University of Parma, Parma, Italy
| | - Magdalena Maria Cattaneo
- Human Medicine Department, Università della Svizzera italiana, Lugano, Switzerland
- Cardiovascular Research Unit, Hospital of San Giovanni, Bellinzona, Switzerland
| | - Adel Younes
- Cardiology Department, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Camilla Gallino
- Human Medicine Department, Università della Svizzera italiana, Lugano, Switzerland
- Cardiovascular Research Unit, Hospital of San Giovanni, Bellinzona, Switzerland
| | - Isabella Sudano
- Human Medicine Department, University of Zurich, Zurich, Switzerland
- Cardiology Department, University Hospital, University Heart Center Zurich, Zurich, Switzerland
| | - Augusto Gallino
- Human Medicine Department, Università della Svizzera italiana, Lugano, Switzerland
- Cardiovascular Research Unit, Hospital of San Giovanni, Bellinzona, Switzerland
- Human Medicine Department, University of Zurich, Zurich, Switzerland
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Abstract
Introduction Stroke is a disease whose consequences have a considerable impact on the quality of the patient’s life. It is a widespread disease that has a disabling impact on life and, in addition to physical changes, brings about a number of psychological and cognitive processes. Goal The goal of the study was to identify and describe the quality of life of post-stroke patients. Methodology The study design was quantitative. A questionnaire of the authors’ own design and the SF-36 questionnaire were used to obtain the data. Results Significant differences in patient quality of life were identified in relation to patient gender. Moreover, the quality of life in all individual SF-36 dimensions, except for mental health, deteriorated with age. With regard to occupational placement, employed respondents gave the highest evaluation of quality of life according to SF-36 and old-age pensioners the lowest. The analysis shows that quality of life in individual dimensions is positively influenced by respondents’ higher education. The evaluation in individual dimensions improves with the time that has passed since the stroke. Conclusion The quality of life of post-stroke patients deteriorates with age. The deteriorating level of patient quality of life in older age requires programmes that include assessments and interventions that lead to the treatment of these patients.
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Abstract
There are stark inequities in stroke incidence, prevalence, acute care, rehabilitation, risk factor control, and outcomes. To address these inequities, it is critical to engage communities in identifying priorities and designing, implementing, and disseminating interventions. This issue of Stroke features health equity themed lectures delivered during the International Stroke Conference and Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving meetings in 2021 as well as articles covering issues of disparities and diversity in stroke. Bruce Ovbiagele, MD, MSc, MAS, MBA, MLS, received the 2021 William Feinberg Award Lecture for his lifetime achievements in seeking global and local solutions to cerebrovascular health inequities. The second annual Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving symposium, which took place the day before the International Stroke Conference in February 2021, focused on community-engaged research for reducing inequities in stroke. Phil Gorelick, MD was awarded the Edgar J. Kenton III Award for his lifetime achievements in using community engagement strategies to recruit and retain Black participants in observational studies and clinical trials. Walter Koroshetz, MD, Director of the National Institute of Neurological Disorders and Stroke delivered the keynote lecture on stroke inequities and Richard Benson, MD, PhD, Director of the Office of Global Health and Health Disparities at National Institute of Neurological Disorders and Stroke, gave a lecture focused on National Institute of Neurological Disorders and Stroke efforts to address inequities. Nichols et al highlighted approaches of community-based participatory research to address stroke inequities. Verma et al showcased digital health innovations to reduce inequities in stroke. Das et al showed that the proportion of underrepresented in medicine vascular neurology fellows has lowered over the past decade and authors provided a road map for enhancing the diversity in vascular neurology. Clearly, to overcome inequities, multipronged strategies are required, from broadening representation among vascular neurology faculty to partnering with communities to conduct research with meaningful impact.
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Affiliation(s)
- Amytis Towfighi
- University of Southern California, Los Angeles (A.T.).,Los Angeles County-Department of Health Services, CA (A.T.)
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Rachiotis G, Papagiannis D, Dardavesis T, Behrakis P. Mortality and morbidity from infectious and non-communicable diseases in Greece during Axis/Nazi military occupation (1941-1944). LE INFEZIONI IN MEDICINA 2022; 30:150-155. [PMID: 35350253 PMCID: PMC8929728 DOI: 10.53854/liim-3001-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
Greece has been severely damaged by the Second World War and the subsequent military occupation of the country by the Axis forces headed by Nazi Germany. The Greek society and economy were dislocated as a result of plundering of the country's vital resources, as well as enforced payments, instead paid to the occupying forces. The dramatic food shortages and famine appeared plaguing especially large cities. There is very limited information on the trends of mortality and morbidity (1941-1944) at a national level. The morbidity and mortality statistics of the General Statistical Service of Greece were assessed and the incidence morbidity and mortality rates have been calculated. As denominator population we used the population of Greece according to 1940 census. The morbidity due to exanthematic typhus, typhoid fever, dysentery and meningitis has been elevated over the period 1940-1944. An elevated specific mortality due to tuberculosis, malaria and typhoid fever was observed over the period 1940-1941. Regarding non-communicable diseases, the mortality due to hemorrhagic stroke was increased after 1940. In conclusion, we found that the Axis/Nazi military occupation of Greece had considerable health effects on infectious diseases and hemorrhagic stroke mortality. Deaths ostensibly due to infectious diseases (e.g. tuberculosis or malaria), were expedited by the hunger famine of the period under investigation. With regard to the elevated mortality due to hemorrhagic stroke, we believe that the stressful events of occupation and famine have triggered increased psychosocial stress which in turn may have increased the risk of hemorrhagic stroke mortality during the period of Axis/Nazi occupation of Greece.
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Affiliation(s)
- Georgios Rachiotis
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Theodoros Dardavesis
- Department of Hygiene, Social-Preventative Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Greece
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Li H, He P, Zhang Y, Lin T, Liu C, Xie D, Liang M, Wang G, Nie J, Song Y, Liu L, Wang B, Zhang Y, Li J, Huo Y, Wang X, Hou FF, Xu X, Qin X. Self-Perceived Psychological Stress and Risk of First Stroke in Treated Hypertensive Patients. Psychosom Med 2022; 84:237-243. [PMID: 34654026 DOI: 10.1097/psy.0000000000001030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to investigate the prospective association between self-perceived psychological stress and first stroke, and to examine possible effect modifiers among adults with hypertension. METHODS A total of 20,688 hypertensive adults with information on self-perceived psychological stress at baseline were included from the China Stroke Primary Prevention Trial. Participants were randomly assigned to a double-blind treatment of receiving a single tablet daily with either 10 mg enalapril and 0.8 mg folic acid or 10 mg enalapril alone. Follow-up visits occurred every 3 months after randomization. Psychological stress was measured with a one-item 3-point rating scale. The primary outcome was first stroke (fatal or nonfatal). RESULTS The median treatment period was 4.5 years. Compared with participants with low levels of psychological stress, those with high psychological stress had a significantly higher risk of first stroke (adjusted hazard ratio = 1.40, 95% confidence interval = 1.01 to 1.94) or first ischemic stroke (adjusted hazard ratio = 1.45; 95% confidence interval = 1.01 to 2.09). Moreover, a stronger positive relationship between psychological stress and first stroke was found in participants with time-averaged mean arterial pressure <101 mm Hg (median; p-interaction = .004) during the treatment period. However, our study did not find a significant association between psychological stress and first hemorrhagic stroke. CONCLUSIONS Higher psychological stress was associated with an increased risk of first stroke among treated hypertensive patients, especially in those with lower mean arterial pressure during the treatment period.
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Affiliation(s)
- Huan Li
- From the Division of Nephrology, Nanfang Hospital, Southern Medical University (Li, He, Zhang, Xie, Liang, Wang, Nie, Hou, Xu, Qin); National Clinical Research Center for Kidney Disease (Li, He, Zhang, Xie, Liang, Wang, Nie, Hou, Xu, Qin); State Key Laboratory of Organ Failure Research (Li, He, Zhang, Xie, Liang, Wang, Nie, Hou, Xu, Qin); Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory (Li, He, Zhang, Xie, Liang, Wang, Nie, Hou, Xu, Qin); Guangdong Provincial Clinical Research Center for Kidney Disease (Li, He, Zhang, Xie, Liang, Wang, Nie, Hou, Xu, Qin), Guangzhou; Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing (Lin, Song, Liu, Xu); Institute of Biomedicine, Anhui Medical University, Hefei (Liu, Wang, Qin); Shenzhen Evergreen Medical Institute, Shenzhen (Liu, Song, Wang); Department of Cardiology, Peking University First Hospital, Beijing (Zhang, Li, Huo); and Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (Wang)
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Ovbiagele B. The 2021 William Feinberg Award Lecture Seeking Glocal Solutions to Cerebrovascular Health Inequities. Stroke 2022; 53:643-653. [DOI: 10.1161/strokeaha.121.034563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Global and local (“glocal”) disparities in stroke incidence, prevalence, care, and mortality are persistent, pervasive, and progressive. In particular, the disproportionate burden of stroke in people of African ancestry compared to most other racial/ethnic groups around the world has been long standing, is expected to worsen, and so far, has defied solution, largely because conventional risk factors likely account for less than half of the Black versus White disparity in stroke outcomes. While hypotheses such as a differential impact or inadequate evaluation of traditional risk factors by race have been suggested as potentially key factors contributing to lingering racial/ethnic stroke disparities, relatively understudied novel risk factors such as psychosocial stress, environmental pollution, and inflammation; and influences of the social determinants of health are gaining the most attention (and momentum). Moreover, it is increasingly recognized that while there is a lot still to understand, there needs to be a major shift from incessantly studying the problem, to developing interventions to resolve it. Resolution will likely require targeting multilevel factors, considering contemporaneous cross-national and cross-continental data collection, creating scalable care delivery models, jointly addressing care quality and community drivers of stroke occurrence, incorporating policy makers in planning/dissemination of successful interventions, and investing in robust transdisciplinary research training programs that address the interrelated issues of health equity and workforce diversity, and regional capacity building. To this end, our international multidisciplinary team has been involved in conducting several epidemiological studies and clinical trials in the area of stroke disparities, as well as executing career enhancing research training programs in the United States and Africa. This award lecture paper shares some of the lessons we have learnt from previous studies, presents objectives/design of ongoing initiatives, and discusses plans for the future.
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Affiliation(s)
- Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco
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40
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Wei D, Li J, Chen H, Fang F, Janszky I, Ljung R, László KD. Death of a Child and the Risk of Stroke: A Binational Cohort Study From Denmark and Sweden. Neurology 2022; 98:e1104-e1113. [PMID: 34996877 DOI: 10.1212/wnl.0000000000013263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/14/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The death of a child is an extreme life event with potentially long-term health consequences. Accumulating evidence suggests that parents who lost a child have increased risks of cardiovascular diseases, including ischemic heart disease and atrial fibrillation. Whether bereaved parents have an increased risk of stroke is unclear and was investigated in this study. METHODS We conducted a population-based cohort study including parents who had a child born during 1973-2016 or 1973-2014 and recorded in the Danish and the Swedish Medical Birth Registers, respectively. We obtained information on child's death, parent's stroke and socioeconomic and health-related characteristics through linkage between several population-based registers. We used Poisson regression to examine the association between the death of a child and the risk of stroke. RESULTS Of the 6,711,955 study participants, 128,744 (1.9%) experienced the death of a child and 141,840 (2.1%) had a stroke during the follow-up. Bereaved parents had an increased risk of stroke; the corresponding incidence rate ratio (95% confidence intervals) was 1.23 (1.19-1.27). The association was present for all analyzed categories of causes of child death (cardiovascular, other natural and unnatural death), did not differ substantially according to the age of the deceased child, but was stronger if the parent had no or ≥3 than 1-2 live children at the time of the loss. The association was similar for ischemic and hemorrhagic stroke. The risk for hemorrhagic stroke was highest immediately after the death of a child and decreased afterwards. In contrast, there was no clear pattern over time in case of ischemic stroke. DISCUSSION The death of a child was associated with a modestly increased risk of stroke. The finding that an association was observed in case of unnatural deaths is suggestive of the explanation that bereavement-related stress may contribute to the development of stroke. Though the death of a child can often not be avoided, an understanding of its health-related consequences may highlight the need for improved support and attention from family members and healthcare professionals.
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Affiliation(s)
- Dang Wei
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Hua Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Imre Janszky
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Swedish Medical Products Agency, Uppsala, Sweden
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Domínguez RO, Marschoff ER, Oudkerk LM, de la Ossa Angulo LE, Pérez SV, Bianchi GA, Repetto MG, Serra JA. Neurological Disorders in an Elderly Cohort Experienced Past Stressful Events: A Retrospective-prospective Study. Curr Aging Sci 2022; 15:163-171. [PMID: 35040423 DOI: 10.2174/1874609815666220118104234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Psychological stress may be a risk factor for dementia, but the association between exposure to stressful life events and the development of cognitive dysfunction has not been conclusively demonstrated. We hypothesize that if a stressful event has an impact on the subjects, its effects would be different in the three diseases. OBJECTIVE This study aims to assess the effects of stressful events in senior patients who later developed ischemic stroke, Alzheimer's, or Parkinson's disease. MATERIAL AND METHODS Together with demographic variables (age, sex, race, socioeconomic and cultural levels), five types of past stressful events, such as death or serious illness of close relatives, job dismissal, change of financial status, retirement, and change of residence, were recorded in 1024 patients with Alzheimer's disease, Parkinson's disease, and ischemic stroke. Time-todiagnosis (months from the event to the first symptoms: retrospective study) and evolution time (years of follow-up of each patient: prospective study) were recorded. The variance and nonparametric methods were analyzed to the variables time-to-diagnosis and evolution time to analyze differences between these diseases. RESULTS The demographic variables, such as age, sex, race, economic and cultural levels, were found to be statistically non-significant; differences in the economic level were significant (P<0.05). Significant differences (P<0.001) were found in the mean time-to-diagnosis between diseases (Alzheimer's disease>Parkinson's disease >Stroke), and minor differences (P<0.05) in evolution time. CONCLUSION Differences in time-to-diagnosis between the diseases indicate that the stressful effect of having experienced the death or serious illness of a close relative has an impact on their emergence. The measurement of time-to-diagnosis and evolution time proves useful in detecting differences between diseases.
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Affiliation(s)
- Raúl O Domínguez
- Department of Neurology, School of Medicine, University of Buenos Aires (UBA), Hospital Sirio-Libanés; Campana 4658, C1419AHN, CABA, Argentina
| | - Enrique R Marschoff
- Antarctic Argentine Institute; 25 de Mayo 1149, B1650HMK, General San Martín, Buenos Aires, Argentina
| | - Liliana M Oudkerk
- Department of Neurology, School of Medicine, University of Buenos Aires (UBA), Hospital Sirio-Libanés; Campana 4658, C1419AHN, CABA, Argentina
| | - Luis E de la Ossa Angulo
- Department of Internal Medicine, School of Medicine, University of Buenos Aires (UBA), Hospital Sirio-Libanés; Campana 4658, C1419AHN, CABA, Argentina
| | - Susana Villamizar Pérez
- Department of Internal Medicine, School of Medicine, University of Buenos Aires (UBA), Hospital Sirio-Libanés; Campana 4658, C1419AHN, CABA, Argentina
| | - Graciela A Bianchi
- Department of Internal Medicine, School of Medicine, University of Buenos Aires (UBA), Hospital Sirio-Libanés; Campana 4658, C1419AHN, CABA, Argentina
| | - Marisa G Repetto
- School of Biochemistry and Pharmacy, General and Inorganic Chemistry Division, National Council of Scientific and Technical Investigations (CONICET), Oxidative Stress Lab, Institute of Biochemistry and Molecular Medicine (IBIMOL), University of Buenos Aires (UBA), Junín 954, C1113AAD, CABA, Argentina
| | - Jorge A Serra
- School of Biochemistry and Pharmacy, Institute of Biochemistry and Molecular 5Medicine (IBIMOL), National Council of Scientific and Technical Investigations (CONICET), Oxidative Stress Lab, University of Buenos Aires (UBA), Junín 954, C1113AAD, CABA, Argentina
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Qureshi N, Zahid S, Saleem A. COVID-19: A relationship between stress and stroke in younger population. Int J Prev Med 2022; 13:9. [PMID: 35281977 PMCID: PMC8883671 DOI: 10.4103/ijpvm.ijpvm_719_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/01/2021] [Indexed: 11/07/2022] Open
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Jerez MP, Madero-Cabib I. Trajectories of family and employment stress associated with cerebrovascular accidents. Rev Saude Publica 2021; 55:101. [PMID: 34910029 PMCID: PMC8621564 DOI: 10.11606/s1518-8787.20210550033253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/07/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES: Reconstruct types of simultaneous stress trajectories in the family and employment domain at different stages of life and estimate their association with cerebrovascular accident (CVA) in old age. METHODS: We used a retrospective, face-to-face, representative survey of people aged 65 to 75 years in the city of Santiago, Chile, (n = 802). We performed a multichannel sequence analysis to reconstruct family and employment stress trajectory types at various life stages and then used logistic regression models to estimate the association of these trajectory types with CVA in old age, controlled for traditional cardiovascular risk factors. RESULTS: Four representative types of family and employment stress trajectories were identified: (1) Absence of family and employment stress, (2) Absence of family stress, persistent employment stress, (3) Absence of family stress, out of the labor market, and (4) Persistent family stress, absence of employment stress. The 61.7% of the sample followed trajectories marked by the permanent presence of family and/or employment stress. Likewise, 18.3% had a trajectory characterized by prolonged absence from the labor market. Individuals with persistent family or employment stress trajectories, as well as those with extended periods of inactivity, are more at risk of developing CVA. CONCLUSIONS: Stress is a risk factor for cardiovascular disease experienced by many people at different stages and domains of life on a prolonged basis. Consequently, prevention systems for this type of chronic diseases should emphasize the highly harmful effects of daily and cumulatively stressful life experiences. This could mitigate the multiple health and financial consequences associated with CVA.
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Affiliation(s)
- María Pilar Jerez
- Magíster en Salud Pública. Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Ignacio Madero-Cabib
- Pontificia Universidad Católica de Chile. Instituto de Sociología & Departamento de Salud Pública. Santiago, Chile.,Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV). Santiago, Chile
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Santosa A, Rosengren A, Ramasundarahettige C, Rangarajan S, Chifamba J, Lear SA, Poirier P, Yeates KE, Yusuf R, Orlandini A, Weida L, Sidong L, Yibing Z, Mohan V, Kaur M, Zatonska K, Ismail N, Lopez-Jaramillo P, Iqbal R, Palileo-Villanueva LM, Yusufali AH, AlHabib KF, Yusuf S. Psychosocial Risk Factors and Cardiovascular Disease and Death in a Population-Based Cohort From 21 Low-, Middle-, and High-Income Countries. JAMA Netw Open 2021; 4:e2138920. [PMID: 34910150 PMCID: PMC8674745 DOI: 10.1001/jamanetworkopen.2021.38920] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022] Open
Abstract
Importance Stress may increase the risk of cardiovascular disease (CVD). Most studies on stress and CVD have been conducted in high-income Western countries, but whether stress is associated with CVD in other settings has been less well studied. Objective To investigate the association of a composite measure of psychosocial stress and the development of CVD events and mortality in a large prospective study involving populations from 21 high-, middle-, and low-income countries across 5 continents. Design, Setting, and Participants This population-based cohort study used data from the Prospective Urban Rural Epidemiology study, collected between January 2003 and March 2021. Participants included individuals aged 35 to 70 years living in 21 low-, middle-, and high-income countries. Data were analyzed from April 8 to June 15, 2021. Exposures All participants were assessed on a composite measure of psychosocial stress assessed at study entry using brief questionnaires concerning stress at work and home, major life events, and financial stress. Main Outcomes and Measures The outcomes of interest were stroke, major coronary heart disease (CHD), CVD, and all-cause mortality. Results A total of 118 706 participants (mean [SD] age 50.4 [9.6] years; 69 842 [58.8%] women and 48 864 [41.2%] men) without prior CVD and with complete baseline and follow-up data were included. Of these, 8699 participants (7.3%) reported high stress, 21 797 participants (18.4%) reported moderate stress, 34 958 participants (29.4%) reported low stress, and 53 252 participants (44.8%) reported no stress. High stress, compared with no stress, was more likely with younger age (mean [SD] age, 48.9 [8.9] years vs 51.1 [9.8] years), abdominal obesity (2981 participants [34.3%] vs 10 599 participants [19.9%]), current smoking (2319 participants [26.7%] vs 10 477 participants [19.7%]) and former smoking (1571 participants [18.1%] vs 3978 participants [7.5%]), alcohol use (4222 participants [48.5%] vs 13 222 participants [24.8%]), and family history of CVD (5435 participants [62.5%] vs 20 255 participants [38.0%]). During a median (IQR) follow-up of 10.2 (8.6-11.9) years, a total of 7248 deaths occurred. During the course of follow-up, there were 5934 CVD events, 4107 CHD events, and 2880 stroke events. Compared with no stress and after adjustment for age, sex, education, marital status, location, abdominal obesity, hypertension, smoking, diabetes, and family history of CVD, as the level of stress increased, there were increases in risk of death (low stress: hazard ratio [HR], 1.09 [95% CI, 1.03-1.16]; high stress: 1.17 [95% CI, 1.06-1.29]) and CHD (low stress: HR, 1.09 [95% CI, 1.01-1.18]; high stress: HR, 1.24 [95% CI, 1.08-1.42]). High stress, but not low or moderate stress, was associated with CVD (HR, 1.22 [95% CI, 1.08-1.37]) and stroke (HR, 1.30 [95% CI, 1.09-1.56]) after adjustment. Conclusions and Relevance This cohort study found that higher psychosocial stress, measured as a composite score of self-perceived stress, life events, and financial stress, was significantly associated with mortality as well as with CVD, CHD, and stroke events.
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Affiliation(s)
- Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Chinthanie Ramasundarahettige
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Jephat Chifamba
- College of Health Sciences, Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | - Scott A. Lear
- Faculty of Health Sciences, Simon Fraser University c/o Healthy Heart Program, St Paul’s Hospital, Vancouver, Canada
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Karen E. Yeates
- Department of Medicine, Etherington Hall, Queen’s University, Kingston, Canada
| | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | - Andreas Orlandini
- Estudios Clínicos Latino America, Instituto Cardiovascular de Rosario, Santa Fe, Argentina
| | - Liu Weida
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Li Sidong
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Zhu Yibing
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr, Mohan’s Diabetes Specialities Centre, Chennai, India
| | - Manmeet Kaur
- School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Noorhassim Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | | | | | - Khalid F. AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salim Yusuf
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Canada
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45
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Chronic social defeat stress causes retinal vascular dysfunction. Exp Eye Res 2021; 213:108853. [PMID: 34800481 DOI: 10.1016/j.exer.2021.108853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The roles of vascular dysfunction and chronic stress have been extensively discussed in the pathophysiology of glaucoma. Our aim was to test whether chronic stress causes retinal vascular dysfunction and therewith induces retinal ganglion cells (RGCs) loss. METHODS Twelve mice underwent chronic social defeat (CSD) stress, while 12 mice received control treatment only. Intraocular pressure (IOP) was measured with a rebound tonometer. Blood plasma corticosterone concentration and adrenal gland weight were used to assess stress levels. Brn-3a staining in retinas and PPD staining in optic nerve cross sections were conducted to assess the survival of RGCs and axons respectively. The ET-1 and α-SMA levels were determined in retina. Retinal vascular autoregulation, functional response to various vasoactive agents and vascular mechanics were measured using video microscopy. RESULTS No significant difference in IOP levels was observed during and after CSD between CSD mice and controls. CSD stress caused hypercortisolemia 2 days post-CSD. However, increased corticosterone levels went back to normal 8 months after CSD. CSD-exposed mice developed adrenal hyperplasia 3 days post-CSD, which was normalized by 8 months. RGC and axon survival were similar between CSD mice and controls. However, CSD stress caused irreversible, impaired autoregulation and vascular dysfunction of retinal arterioles in CSD mice. In addition, impaired maximal dilator capacity of retinal arterioles was observed 8 months post-CSD rather than 3 days post-CSD. Remarkably, ET-1 levels were increased 3 days post-CSD while α-SMA levels were decreased 8 months post-CSD. CONCLUSIONS We found that CSD stress does not cause IOP elevation, nor loss of RGCs and their axons. However, it strikingly causes irreversible impaired autoregulation and endothelial function in murine retinal arterioles. In addition, CSD changed vascular mechanics on a long-term basis. Increased ET-1 levels and loss of pericytes in retina vessels may involve in this process.
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Yao H, Zhang J, Wang Y, Wang Q, Zhao F, Zhang P. Stroke risk and its association with quality of life: a cross-sectional study among Chinese urban adults. Health Qual Life Outcomes 2021; 19:236. [PMID: 34627278 PMCID: PMC8501711 DOI: 10.1186/s12955-021-01868-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of mortality and disability worldwide. Most stroke risk studies focused on more established biological and pathophysiological risk factors such as hypertension and smoking, psychosocial factors such as quality of life are often under-investigated and thus less reported. The current study aims to estimate stroke risk and explore the impact of quality of life on stroke risk among a community sample of urban residents in Shanghai. METHODS This cross-sectional study was conducted in Fengxian District of Shanghai City from December 2018 to April 2019. 4030 representative participants were recruited through a multistage, stratified, probability proportional to size sampling method and completed the study. Stroke risk was assessed using the Rapid Stroke Risk Screening Chart that included 8 risk factors for stroke. Quality of life was measured using the World Health Organization Quality of Life-brief version (WHOQOL-BREF). RESULTS One-third of residents were at risk for stroke, including 14.39% at high risk, and 18.68% at middle risk. The top three most commonly reported risk factors were physical inactivity (37.30%), hypertension (25.38%), and smoking (17.32%). Quality of life and its four domains were all independently and significantly associated with stroke risk. Multinominal logistic regressions showed that a one-unit increase in the quality of life was associated with a decreased relative risk for middle-risk relative to low-risk of stroke by a factor of 0.988 (95% CI:0.979, 0.997, P = 0.007), and a decreased relative risk for high-risk relative to low-risk of stroke by a factor of 0.975 (95% CI:0.966, 0.984, P < 0.001). CONCLUSIONS Our findings showed an alarmingly high prevalence of stroke risk among the sample, which may require future intervention programs to focus on improving both biological and behavioral risk factors such as increasing physical activity, early diagnosis and treatment of hypertension, and smoking cessation, as well as improving psychosocial factors such as quality of life.
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Affiliation(s)
- Huiqing Yao
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing, 100730, People's Republic of China
| | - Juhua Zhang
- Fudan University, Shanghai, 200433, People's Republic of China.,Shanghai Pudong Health Development Research Institute, Shanghai, 200129, People's Republic of China.,Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People's Republic of China
| | - Yanmei Wang
- Department of Nursing, Shanghai Gongli Hospital, Second Military Medical University, Shanghai, 200135, People's Republic of China
| | - Qingqing Wang
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing, 100730, People's Republic of China
| | - Fei Zhao
- Clinical Trial Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing, 100730, People's Republic of China.
| | - Peng Zhang
- Department of Neurology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, 201800, People's Republic of China. .,School of Clinical Medicine, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, People's Republic of China.
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Münzel T, Hahad O, Sørensen M, Lelieveld J, Duerr GD, Nieuwenhuijsen M, Daiber A. Environmental risk factors and cardiovascular diseases: a comprehensive review. Cardiovasc Res 2021; 118:2880-2902. [PMID: 34609502 PMCID: PMC9648835 DOI: 10.1093/cvr/cvab316] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 12/12/2022] Open
Abstract
Noncommunicable diseases (NCDs) are fatal for more than 38 million people each year and are thus the main contributors to the global burden of disease accounting for 70% of mortality. The majority of these deaths are caused by cardiovascular disease. The risk of NCDs is strongly associated with exposure to environmental stressors such as pollutants in the air, noise exposure, artificial light at night and climate change, including heat extremes, desert storms and wildfires. In addition to the traditional risk factors for cardiovascular disease such as diabetes, arterial hypertension, smoking, hypercholesterolemia and genetic predisposition, there is a growing body of evidence showing that physicochemical factors in the environment contribute significantly to the high NCD numbers. Furthermore, urbanization is associated with accumulation and intensification of these stressors. This comprehensive expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. We will also discuss solutions and mitigation measures to lower the impact of environmental risk factors with focus on cardiovascular disease.
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Affiliation(s)
- Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany
| | - Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Jos Lelieveld
- Max Planck Institute for Chemistry, Atmospheric Chemistry Department, Mainz, Germany
| | - Georg Daniel Duerr
- Department of Cardiac Surgery, University Medical Center Mainz, Johannes Gutenberg University, Germany
| | - Mark Nieuwenhuijsen
- Institute for Global Health (ISGlobal), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Andreas Daiber
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany
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Mokhber N, Sheikh Andalibi MS, Morovatdar N, Thrift AG, Kapral MK, Stranges S, Saber H, Farzadfard MT, Amiri A, Akbarzadeh F, Ghanei N, Khorram B, Azarpazhooh MR. Self-perceived acute psychological stress and risk of mortality, recurrence and disability after stroke: Mashhad Stroke Incidence Study. Stress Health 2021; 37:819-825. [PMID: 33481317 DOI: 10.1002/smi.3031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 01/25/2023]
Abstract
This longitudinal study was designed to evaluate the association between acute pre-stroke stress and the severity stroke and its outcomes including mortality, recurrence, disability and functional dependency. Patients with first-ever stroke (FES) were recruited from the Mashhad Stroke Incidence Study. Patients were asked about any acute severe pre-stroke stress in the 2 weeks prior to index stroke. Disability and functional disability were defined using modified the Rankin Scale and Barthel Index, respectively. We used logistic and ordinal regression tests to assess the association between acute pre-stroke stress and study outcomes. Among 624 patients with FES, 169 reported acute pre-stroke stress. Patients with acute pre-stroke stress were younger than those without stress (60.7 ± 14.4 vs. 66.2 ± 14.7; p < 0.001). The frequency of traditional vascular risk factors was not different in patients with and without acute pre-stroke stress. We did not find any association between acute pre-stroke stress and stroke outcomes. Although acute stress was common in our cohort, our results did not support an association between acute pre-stroke stress and the severity of stroke at admission and long-term stroke outcomes.
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Affiliation(s)
- Naghmeh Mokhber
- Department of Psychiatry, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Psychiatry & Behavioral Neurosciences, Western University, London, Canada
| | - Mohammad Sobhan Sheikh Andalibi
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Morovatdar
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Clayton, Australia
| | - Moira K Kapral
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Saverio Stranges
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Hamidreza Saber
- David Geffen School of Medicine, Comprehensive Stroke Center, Department of Neurology, University of California, Los Angeles, USA
| | | | - Amin Amiri
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Akbarzadeh
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Ghanei
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Khorram
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Reza Azarpazhooh
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Clinical Neurological Science, University Hospital, London Health Science Center, Western University, London, Canada
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Luton OW, James OP, Mellor K, Eley C, Hopkins L, Robinson DBT, Lebares CC, Powell AGMT, Lewis WG, Egan RJ. Enhanced stress-resilience training for surgical trainees. BJS Open 2021; 5:6330409. [PMID: 34323917 PMCID: PMC8320339 DOI: 10.1093/bjsopen/zrab054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction Core surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training (ESRT) course delivered at the start of core surgical training in a single UK statutory education body. Method All newly appointed core surgical trainees (CSTs) were invited to participate in a 5-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. The primary aim was to assess the feasibility of this course; secondary outcomes were to assess degree of burnout measured using Maslach Burnout Inventory (MBI) scoring. Results Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate in ESRT (63.2 per cent; male 13, female 11, median age 28 years). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas, time pressures related to academic curriculum demands and the concurrent COVID-19 pandemic (10 of 24 drop-out). Despite these challenges, 22 (91.7 per cent) considered the course valuable and there was unanimous support for programme development. Of the 14 trainees who completed the ESRT course, nine (64.3 per cent) continued to use the techniques in daily clinical work. Burnout was identified in 23 trainees (60.5 per cent) with no evident difference in baseline MBI scores between participants (median 4 (range 0–11) versus 5 (1–11), P = 0.770). High stress states were significantly less likely, and mindfulness significantly higher in the intervention group (P < 0.010); MBI scores were comparable before and after ESRT in the intervention cohort (P = 0.630, median 4 (range 0–11) versus 4 (1–10)). Discussion Despite arduous emergency COVID rotas ESRT was feasible and, combined with protected time for trainees to engage, deserves further research to determine medium-term efficacy.
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Affiliation(s)
- O W Luton
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - O P James
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - K Mellor
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - C Eley
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - L Hopkins
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - D B T Robinson
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - C C Lebares
- University of California, San Francisco, California, USA
| | - A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Heath Park, Cardiff, UK
| | - W G Lewis
- Health Education and Improvement Wales' School of Surgery, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
| | - R J Egan
- Department of Surgery, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK.,Swansea University, Swansea, UK
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de Vries H, Kamphuis W, Oldenhuis H, van der Schans C, Sanderman R. Moderation of the Stressor-Strain Process in Interns by Heart Rate Variability Measured with a Wearable and Smartphone App: a Within-Subject Design Using Continuous Monitoring. JMIR Cardio 2021; 5:e28731. [PMID: 34319877 PMCID: PMC8524333 DOI: 10.2196/28731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background The emergence of smartphones and wearable sensor technologies enables easy and unobtrusive monitoring of physiological and psychological data related to an individual’s resilience. Heart rate variability (HRV) is a promising biomarker for resilience based on between-subject population studies, but observational studies that apply a within-subject design and use wearable sensors in order to observe HRV in a naturalistic real-life context are needed. Objective This study aims to explore whether resting HRV and total sleep time (TST) are indicative and predictive of the within-day accumulation of the negative consequences of stress and mental exhaustion. The tested hypotheses are that demands are positively associated with stress and resting HRV buffers against this association, stress is positively associated with mental exhaustion and resting HRV buffers against this association, stress negatively impacts subsequent-night TST, and previous-evening mental exhaustion negatively impacts resting HRV, while previous-night TST buffers against this association. Methods In total, 26 interns used consumer-available wearables (Fitbit Charge 2 and Polar H7), a consumer-available smartphone app (Elite HRV), and an ecological momentary assessment smartphone app to collect resilience-related data on resting HRV, TST, and perceived demands, stress, and mental exhaustion on a daily basis for 15 weeks. Results Multiple linear regression analysis of within-subject standardized data collected on 2379 unique person-days showed that having a high resting HRV buffered against the positive association between demands and stress (hypothesis 1) and between stress and mental exhaustion (hypothesis 2). Stress did not affect TST (hypothesis 3). Finally, mental exhaustion negatively predicted resting HRV in the subsequent morning but TST did not buffer against this (hypothesis 4). Conclusions To our knowledge, this study provides first evidence that having a low within-subject resting HRV may be both indicative and predictive of the short-term accumulation of the negative effects of stress and mental exhaustion, potentially forming a negative feedback loop. If these findings can be replicated and expanded upon in future studies, they may contribute to the development of automated resilience interventions that monitor daily resting HRV and aim to provide users with an early warning signal when a negative feedback loop forms, to prevent the negative impact of stress on long-term health outcomes.
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Affiliation(s)
- Herman de Vries
- Professorship Personalized Digital Health, Hanze University of Applied Sciences, Zernikeplein 11, Groningen, NL.,Department of Human Behaviour & Training, TNO, Soesterberg, NL.,Department of Health Psychology, University Medical Center Groningen, Groningen, NL
| | - Wim Kamphuis
- Department of Human Behaviour & Training, TNO, Soesterberg, NL
| | - Hilbrand Oldenhuis
- Professorship Personalized Digital Health, Hanze University of Applied Sciences, Zernikeplein 11, Groningen, NL
| | - Cees van der Schans
- Department of Health Psychology, University Medical Center Groningen, Groningen, NL.,Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, NL.,Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, NL
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, Groningen, NL.,Department of Psychology, Health and Technology, University of Twente, Enschede, NL
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