To examine the relationship between depression and inflammation, which is associated with heart disease, Halaris and colleagues examined the blood levels of a chemical called Interleukin 6 (IL6). IL6 triggers inflammation via the sympathetic branch (“fight or flight”) of the nervous system [1], and is known to be elevated in patients at risk for cardiovascular disease [2]. Halaris’ research showed that patients with major depressive disorder had significantly higher blood levels of IL6 than healthy (non-depressed) individuals.

The link between the two disease processes can be explained qualitatively via stress, which is strongly associated with depression in a reciprocal relationship (depression can increase stress, and stress can lead to depression). Stress also suppresses the immune system and initiates a variety of inflammatory processes in the body, increasing the risk of heart disease.

Dr. Halaris presented his findings at a joint congress of the World Psychiatric Association (WPA), the International Neuropsychiatric Association (INA) and the Hellenic Society for the Advancement of Psychiatry and Related Sciences (HSAPRS) late last year in Athens, Greece.

Though the exact mechanism through which IL6, depression, and heart disease are linked is not completely understood — thereby justifying the need for more research in this area — the correlation between the disease types is strong enough to warrant that patients with depression be monitored closely for heart disease, and vice versa.

According to Dr. Halaris, 40-60% of heart disease patients suffer clinical depression and 30-50% of patients who suffer clinical depression are at risk of developing cardiovascular disease. He proposes that psychocardiology be treated as a multidisciplinary subspecialty where psychiatrists and cardiologists work together. In a Loyola Medicine press release, he stated [3]:

It is only through the cohesive interaction of such multidisciplinary teams that we can succeed in unraveling the complex relationships among mental stress, inflammation, immune responses and depression, cardiovascular disease and stroke.

References

1. Halaris et al. Interleukin-6 as a biomarker in major depressive disorder. Brain, Behavior, and Immunity. Volume 26, Supplement 1, September 2012, Pages S1. PNIRS 2012 — Brain, Behavior, and Immunity in Health and Disease. PsychoNeuroImmunology Research Society’s 19th Annual Scientific Meeting.
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2. Danesh et al. Long-term interleukin-6 levels and subsequent risk of coronary heart disease: two new prospective studies and a systematic review. PLoS Med. 2008 Apr 8;5(4):e78.
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3. Loyola Psychiatrist Proposes New Subspecialty for Patients Suffering Depression and Heart Disease. Loyola Medicine. 2013 Feb 18.

The purpose of the study was to determine whether nature (genes) or nurture (environment) had a greater influence on how people perceived work stress and job satisfaction. Researchers studied nearly 300 pairs of twins — a mix of identical and fraternal twins — who were raised and educated apart. They used path analysis, a statistical technique used to describe the directed dependencies among a set of variables by breaking down correlations into different pieces for the interpretation of effects, to evaluate the connections between genes and environment, job satisfaction and stress, and physical health.

They found that personality type is associated with job stress and health. Self-evaluations indicated that different perceptions to the work environment influenced satisfaction, stress and health problems. Individuals with a low core self-evaluation, answering negatively to questions such as “When I make plans, I’m almost certain that I can follow them through” or positively to questions such as “I often feel as though I have no control over what happens to me”, perceive more stressors in their work environment, which decreases satisfaction and increases stress and health problems. Conversely, people that feel more optimistic and confident, and less self-critical perceive fewer stressors in their work environment, increasing satisfaction and decreasing stress and health problems.

This result seems somewhat obvious: confident, optimistic people are typically better at handling stress than those that aren’t.

However, what was surprising was that large portion (44%) of the differences in personality type could be attributed to genetics. The researchers found that being raised in the same environment had very little effect on personality, stress and health. Instead, shared genes turned out to be around four times more important than a shared environment. Quite simply, who you are (your genes) is more more important than how you are (your perceptions).

Timothy Judge, Ph.D., professor of management at the University of Notre Dame’s Mendoza College of Business, and lead author on the study, said [2]:

Our study suggests strong heritabilities to work stress and the outcomes of stress. This means that stress may have less to do with the objective features of the environment than to the genetic ‘code’ of the individual. This doesn’t mean we shouldn’t do things as employers or individuals to avoid stressful jobs. However, we also shouldn’t assume that we’re ‘a blank slate’ and therefore be overly optimistic about what the work environment can and can’t do as far as stress is concerned. More of it has to do with what’s inside of us than what we encounter outside in the work environment.

Tips for coping with stress at work

Based on this research, if you’re genetically predisposed to experience workplace stress, switching jobs won’t solve the problem. Here are some tips to better cope with stress at work.

Identify your triggers

Identify the factors causing you stress by keeping a stress inventory. For one week write down the people, events and situations that cause you to have a negative physical, mental or emotional response. For each entry, write down a brief description. Where were you? Who was involved? How did you react? How did you feel After a week, review your stress inventory. Choose one situation, identify and explore the problem, look for ways to resolve it, and implement a solution.

Improve your time management skills

Feeling overloaded is a common cause of stress. Improve your time management skills by setting realistic goals and deadlines for yourself. Review your progress frequently. Every evening before you leave work, prepare a list of tasks for the next day and order them by priority. During the day, limit distractions that make it difficult to focus: check email less frequently and block off time on your schedule for important work or challenging projects.

Maintain perspective

Sometimes work stress can be overwhelming. Talk with your coworkers about your challenges and see how they’re coping. Take short breaks throughout the day to refocus and come back refreshed — take a quick walk and stop staring at that computer screen! Lastly, take care of your health. Get regular exercise, plenty of sleep and eat a healthy diet.

References

1. Judge TA et al. Genetic influences on core self-evaluations, job satisfaction, and work stress: A behavioral genetics mediated model. Organ Behav Hum Decis Process. 2012 Jan 1;117:208-220.
2. Feeling stressed by your job? Don’t blame your employer, study shows. Notre Dame News. 2012 Sep 13.

Answer: Eating a healthy, balanced diet during pregnancy helps to ensure proper fetal development, good maternal health, and appropriate weight gain. The amount each woman needs to eat during pregnancy will depend upon her activity level and pre-pregnancy weight; decisions regarding caloric intake and weight gain during pregnancy should be made in tandem with an obstetrician. In general, however, women who are of appropriate body weight before pregnancy should expect to gain 25–35 pounds by their due date [1]. An increased energy intake of about 340–450 calories per day is generally sufficient to produce the desired weight gain [2]. Note that pregnancy weight gain isn’t all — or even mostly — due to increased body fat. Rather, much of the weight comes from fetal mass, amniotic fluid, increased maternal blood volume, and the weight of the placenta. There is a moderate increase in body fat during a normal pregnancy. Excessive weight gain, however, increases body fat significantly. This puts the mother at increased risk of obesity post-pregnancy, as well as increased risk of a c-section, gestational diabetes, and preeclampsia [3].

While individuals may have specific dietary considerations or restrictions that should be discussed with an obstetrician, a healthy pregnancy diet looks very similar to a healthy diet at any other time. It should be varied and made up of mostly whole foods including fresh fruits and vegetables, lean sources of protein, whole grains, and healthy, plant-based fats. Women who experience significant morning sickness at any time during pregnancy and consequently find their diets quite limited should discuss their concerns with an obstetrician.

Nutritious foods aside, another important component of the pregnancy diet is supplementation with certain key vitamins and minerals. One of the easiest ways to achieve this is to take a prenatal vitamin. Prenatals are quite similar in composition to women’s daily multivitamins, though they’re quite a bit higher in some of the micronutrients — that is, vitamins and minerals — that are critical to a healthy pregnancy. For instance, prenatal vitamins contain significantly more iron than found in women’s daily multivitamins. Evidence suggests that 27–30 mg/day of iron is best during pregnancy, while non-pregnant women need only 18 mg/day [4]. Iron is a key component of hemoglobin, the protein in red blood cells that binds to oxygen and helps deliver it to the tissues. Because blood volume increases significantly during pregnancy, necessitating the synthesis of large quantities of red blood cells, the added iron is of great importance. Another critical micronutrient is folic acid, a B-vitamin that has a number of roles in metabolism and the nervous system. Very early in pregnancy, sufficient stores of folic acid in the mother’s body help to prevent the birth defect spina bifida. Pregnant women should get at least 400-800 mcg (0.4-0.8 mg) of folic acid per day [1]. Additional micronutrients of particular importance during pregnancy include calcium (1000–1300 mg/day [5]) and vitamin D in cases in which there is inadequate sun exposure [1]. While it’s theoretically possible to get all the necessary vitamins and minerals from a balanced diet, it can be difficult to get sufficient quantities — particularly of folic acid and iron — to support a healthy pregnancy from food. The major utility of prenatal supplementation, then, is to act as a sort of insurance.

There is some interesting emerging research in the field of epigenetics — the study of the ways in which environment affects genes — that suggests a woman’s diet during pregnancy may help to determine her developing child’s tastes later in life [6]. That is to say, a woman who eats a high-fat diet during pregnancy may be more likely to produce a child who particularly craves sugary and fatty foods. Further, a high-fat diet and subsequent maternal obesity during pregnancy could increase the likelihood that the offspring will be obese later in life [7]. Still, when it comes to a healthy diet during pregnancy, the best attitude to take is one of moderation. It’s not reasonable to ignore nutrition completely, “eat for two,” and satisfy every craving with high-sugar, high-fat, low-nutrient fare. Neither is it reasonable, however, to worry about the nutritional content of every forkful; if nothing else, the stress of the latter isn’t healthy.

References

1. Kirkham et al. Evidence-Based Prenatal Care: Part I. General Prenatal Care and Counseling Issues. Am Fam Physician. 2005 Apr 1;71(7):1307-16.
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2. Picciano, M. Pregnancy and lactation: physiological adjustments, nutritional requirements and the role of dietary supplements. J Nutr. 2003 Jun;133(6):1997S-2002S.
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3. American College of Obstetrics and Gynecology. ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol. 2005 Sep;106(3):671-5.
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4. Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1998 Apr 3;47(RR-3):1-29.
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5. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 5th ed. Elk Grove Village, Ill.: American Academy of Pediatrics, and Washington, D.C.: American College of Obstetricians and Gynecologists, 2002.
6. Vucetic et al. Maternal high-fat diet alters methylation and gene expression of dopamine and opioid-related genes. Endocrinology. 2010 Oct;151(10):4756-64. Epub 2010 Aug 4.
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7. Wu et al. Parental obesity and overweight affect the body-fat accumulation in the offspring: the possible effect of a high-fat diet through epigenetic inheritance. Obes Rev. 2006 May;7(2):201-8.
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The purpose of Men’s Health Week is to increase awareness of preventable health problems and encourage early detection and treatment of disease among men and boys.

According to the Mayo Clinic, the biggest threats to men’s health can often be prevented [1]. Here’s a list of the top seven threats to men’s health and what you can do to minimize those risks.

1. Heart disease

   Heart disease is the leading cause of death in U.S. males [2]. The good news is that measures can be taken to prevent heart disease. Here’s some things you can do to take charge of your heart health:

   • Don’t smoke. If you do smoke, quit smoking.
   • Eat a healthy diet of fruits, vegetables, whole grains, high-fiber foods, and lean sources of protein.
   • Manage chronic conditions such as high cholesterol or high blood pressure.
   • Include physical activity in your daily routine.
   • Watch your weight.
   • Limit alcohol consumption.
   • Take steps to reduce your stress.
2. Cancer

   The three most common cancers among men are prostate cancer, lung cancer and colorectal cancer [3]. Scientists estimate that about a third of the most common cancers could be prevented through diet and lifestyle [4]. Choose healthy lifestyle alternatives to reduce your risks for developing cancer:

   • Take a daily baby aspirin (75mg).
   • Don’t smoke. Avoid exposure to secondhand smoke.
   • Watch your weight.
   • Include physical activity in your daily routine.
   • Eat a healthy diet of fruits, vegetables, whole grains, high-fiber foods, and lean sources of protein.
   • Use sunscreen and protect yourself from the sun.
   • Limit alcohol consumption.
   • Take early detection seriously. Get regular cancer screenings.
3. Accidents

   Motor vehicle crashes are a leading cause of fatal accidents among men. When driving, use common sense: always wear your seat belt, don’t drive under the influence of drugs or alcohol, and don’t drive when you’re tired. Avoid distractions such as the radio or texting and follow the speed limit (this will also improve your financial health, reduce stress, and help save the planet).

4. Chronic lower respiratory diseases

   Chronic lung conditions such as bronchitis and emphysema are a concern for men. Here’s how you can protect your respiratory health:

   • Don’t smoke.
   • Pay attention to air quality; steer clear of pollutants.
   • Prevent respiratory infections. Wash your hands and get the yearly flu vaccine.
5. Stroke

   Stroke is the most common cause of adult disability. Although you can’t control some stroke risk factors, such as family history, age and race, you can control other contributing factors:

   • Manage chronic conditions such as high cholesterol or high blood pressure.
   • Don’t smoke.
   • Eat a healthy diet.
   • Include physical activity in your daily routine.
   • Limit alcohol consumption.
6. Type 2 diabetes

   Type 2 diabetes is the most common form of diabetes. It is a lifelong disease in which there are high levels of sugar (glucose) in the blood. To prevent type 2 diabetes, eat a healthy diet, exercise, and watch your weight. Research has shown that you can also lower diabetes risk by getting a good nights sleep.If you have diabetes, keep your blood sugar under control. Poorly controlled diabetes can lead to heart disease, eye problems, nerve damage and other complications.

7. Suicide

   Suicide is another leading men’s health risk. An important risk factor for suicide among men is depression. Depression is serious: changes in heart function are seen during major depression. Effective treatments for depression are available. If you have signs and symptoms of depression, such as feelings of sadness or unhappiness and loss of interest in normal activities, talk to your doctor.

The bottom line to men is to take these seven health threats seriously. The actions listed on this page will positively affect your health and increase the likelihood of living a long and healthy life.

References

1. Men’s health: Preventing the top 7 threats. Mayo Clinic. Accessed 2012 Jun 13.
2. Leading Causes of Death in Males United States. Centers for Disease Control and Prevention. Accessed 2012 Jun 13.
3. Cancer Among Men. Centers for Disease Control and Prevention. Accessed 2012 Jun 13.
4. Cancer prevention. World Cancer Research Fund. Accessed 2012 Jun 13.

Stress is at epidemic levels in our population. The American Psychological Association released its Stress in America 2011 Report earlier this year, and according to the report, 73% of us think our stress levels are the same or higher than they were 5 years ago [1]. Ninety-four percent of us believe that stress can contribute to the development of major illnesses such as hypertension, cardiovascular disease, stroke, obesity, diabetes and depression, but only 29% say that they are doing an excellent or good job at managing or reducing stress. Clearly, this is cause for concern.

In observation of Stress Awareness Month this April, here are five proven, successful stress management tips to help you reduce or prevent stress — and as a bonus, none of these include the words “diet” or “exercise”.

1. Laugh. Several studies have established that laughing has psychological benefits. Mirthful (meaning joyful) laughter not only improves your mood, but has positive physiological effects on the immune system [2]. Laughing with someone may be even more beneficial than simply watching a funny video clip or reading comic strips, because a shared laugh does the double work of making you feel more connected to others. This connection is a powerful stress reducer all by itself.

2. Doodle. Any fully absorbing activity undertaken purely for pleasure has the capacity to lower stress, and there is some evidence that doodling may help you pay better attention as well. This method of relaxation, sometimes called zendoodling, has become so popular, entire communities have formed around particular methods. (pictured above is one of this writer’s many doodles)

3. Sing. In the shower. In the car. The kitchen. By yourself. With others. Just sing. Scientists have found that singing is a powerful immune booster and stress reducer, which lights up your brain’s neural activity and improves your mood in less time than it takes to get to the chorus of “Proud Mary”.

4. Give. Stepping out of the myopic perspective of your own stresses and into a giving, compassionate and connected role can radically transform the way you see yourself and others. A simple hug may seem like a small thing, but for your brain and body (as well as for the person you are hugging), it can release high levels of endorphins, which relax the body and produce feelings of well-being. There is much exciting work being funded right now, which hopes to shed light on the neurological correlates of compassion and altruism.

5. Meditate. Perhaps more than any other activity, a daily 20 minute meditation practice can help you reduce stress, improve your immune system, strengthen your brain, and improve your sense of well-being. Even after just 8 weeks, one study’s participants were seeing improved immune response and psychosocial well-being [3]. Another study found that meditation was associated with increases in brain regions involved in learning and memory, emotion regulation, self-referential processing, and perspective taking [4].

About the author: Carter Harkins is co-founder of MindLev.com, a company applying meditation science and neuroacoustic technology to create evidence-based meditation, relaxation and stress relief tools.

References

1. Stress in America: Our Health at Risk. American Psychological Association. 2012 Jan 11.
2. Bennett et al. The effect of mirthful laughter on stress and natural killer cell activity. Altern Ther Health Med. 2003 Mar-Apr;9(2):38-45.
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3. Fang et al. Enhanced psychosocial well-being following participation in a mindfulness-based stress reduction program is associated with increased natural killer cell activity. J Altern Complement Med. 2010 May;16(5):531-8.
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4. Holzel et al. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Res. 2011 Jan 30;191(1):36-43. Epub 2010 Nov 10.
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SAD is a recurrent mood disorder, where depression and fatigue are experienced in around the time of winter [2]. It has been treated with bright light [2], with the logic that the difference in light is causing the symptoms; by manipulating the air ions to increase feelings of relaxation [2]; by antidepressants [3]; and by nutritional interventions to address changes in thyroid function [3]. These myriad of treatments assume different underlying causes of SAD, however the evidence of what makes people to experience SAD remains inconclusive [1].

One idea to explain the experience of SAD involves cortisol. Cortisol levels fluctuate with light and dark or wake and sleep cycles. We experience a burst in cortisol levels around 30-45 minutes after we wake up. This is known as the “cortisol awakening response “and plays a role is getting us up and moving. Cortisol is of great interest to psychologists, as it has been shown time and time again to be related to depression, trauma, stress and cancer. Cortisol is released in response to physical and psychological stress, and may reduce immune cell function. As immune cell function can have an influence on tumor growth, cortisol is the biochemical link between positive psychology and cancer survival. Moreover, cortisol is a predictive biomarker for heart attack. So, does cortisol have a relationship to SAD, given that it is linked to depression and is produced with some response to light/dark in the environment, which changes over the seasons?

In a recent study, Thorn and colleagues recruited two groups of people; those experiencing SAD (SAD group) and those who did not (control group), recruiting control participants who matched the characteristics of the participants reporting SAD [1]. Attempting to ensure that the average age of the participants in each group was similar, for example, strengthens the research as differences between results are unlikely to be because of age or other variables. Participants were asked to provide saliva samples to measure cortisol levels and record what time they woke up, how long they slept for, how well they slept and measures of stress, alertness and depression. Participants completed these tasks during November/December and again during June/July. Each time, they completed the measures on two consecutive days; 26 people experiencing SAD and 26 control participants completed all data.

The results showed that there were no differences in characteristics such as age, gender, non-smoker or smoker between the two groups. Data from the summer months showed no differences in cortisol levels between the groups. This is as expected, as SAD affects people in the winter months. Data from the winter months revealed that cortisol levels around the time of waking up in the SAD group were lower than in the control group. At this time, the SAD group reported significantly more depression, stress and anxiety and significantly lower alertness. The cortisol levels during the rest of the day were no different for the two groups. The difference was that the burst of cortisol that is the awakening response was not seen in the SAD group.

The research suggests that cortisol may be linked to SAD. However, as always, caution must be applied to these findings. First, a limitation of this study is the reliance of self-reported SAD. It is unclear how severe SAD may have been or if other psychological conditions were present in any of the participants. The study took place in the UK, where the winter certainly signals darkness, however this does not necessarily contrast to the British summer! The point here may be that differences in light levels are just one element that is potentially different between the two sets of data collection, other environmental effects such as colder weather, more rain or the stress of the festive period may be relevant to this research. Causality cannot be claimed. Other factors may cause cortisol responses to change. Other factors may cause mood to change. Indeed, experiencing SAD may somehow cause changes in cortisol and not the other way around. Nonetheless, the difference between control and SAD group suggests there is a role for cortisol in SAD.

This study shows that changes in mood and behavior are associated with a seasonal variation in the cortisol awakening response. Cortisol levels during the day were not related to mood and behavior across the seasons, just that initial burst. This work gives a possible explanation for what may be causing SAD and further research directed at establishing cause is needed.

What are the symptoms of SAD?

Symptoms of SAD usually appear in the fall and winter when there is less exposure to sunlight during the day. Not everyone who has SAD experiences the same symptoms. Symptoms include, but are not limited to:

• A drop in energy level
• Fatigue
• Lack of interest in normal activities
• Social withdrawal
• A change in appetite, especially a craving for sweet or starchy foods
• Weight gain
• Irritability and anxiety
• A tendency to oversleep
• Difficulty concentrating

SAD may also include some of the symptoms that occur in other forms of depression, including feelings of guilt, ongoing feelings of hopelessness and physical problems (such as headaches). For additional information, visit Mental Health America’s factsheet on Seasonal Affective Disorder (SAD).

References

1. Thorn et al. Seasonal differences in the diurnal pattern of cortisol secretion in healthy participants and those with self-assessed seasonal affective disorder. Psychoneuroendocrinology. 2010 Dec 8. [Epub ahead of print]
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2. Flory et al. A randomized, placebo-controlled trial of bright light and high-density negative air ions for treatment of Seasonal Affective Disorder. Psychiatry Res. 2010 May 15;177(1-2):101-8. Epub 2010 Apr 9.
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3. Palinkas LA. Nutritional interventions for treatment of seasonal affective disorder. CNS Neurosci Ther. 2010 Spring;16(1):3-5.
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A biomarker is a molecular signature found in blood, other body fluids, or tissues that reflects a normal biologic process, pathogenic process or pharmacologic process to a therapeutic intervention. A biomarker that has been shown to have clinical validity and utility can be used to identify the earliest stages of disease onset, diagnosis, prognosis, efficacy of a specific drug therapy, toxicological effects of a drug, or disease risk.

Cortisol is a stress hormone produced by the adrenal gland; it’s secretion is increased during times of stress. Several studies have linked chronic stress and risk for cardiovascular disease risk, which includes heart attack, chest pain, stroke, high blood pressure and heart failure [4-5]. Cortisol is usually measured in saliva, serum or urine, all of which measure cortisol levels in the last few hours to days and thus don’t reflect the stress response over a prolonged period of time. In contrast, hair analysis provides a long-term measurement of cortisol production; cortisol can be incorporated into hair and remain stable for at least a 6 month period (corresponding to the proximal 6-cm of a human hair sample).

In 2007, twenty-five healthy pregnant women were evaluated for perceived stress and cortisol levels in hair [6]. Maternal hair cortisol was found to be a potential biomarker of chronic stress in pregnancy, as it correlated positively and significantly with measures of perceived stress. In the present study, a larger cohort of 112 patients was used to evaluate the hypothesis that chronic stress, as assessed by hair cortisol content, is associated with the development of acute myocardial infarction (i.e. heart attack). Although acute stress is increasingly recognized as a contributing factor to acute myocardial infarction (AMI), the role of chronic stress has been less clear.

Hair cortisol concentrations were increased in AMI patients

Patients in the current study were divided into two groups of 56 male subjects above the age of 18 years that underwent hair sampling: a control group and an AMI group. The control group consisted of patients admitted to an internal medicine ward for reasons other than acute coronary syndrome or stroke. The AMI group consisted of patients admitted to the Intensive Cardiac Care Unit at the Meir Medical Center in Kfar-Saba, Israel who were suffering from heart attacks, specifically either ST-elevation or non-ST elevation AMI — this corresponds to the S-T segment on an electrocardiogram (during ventrical systolic depolarization, i.e. when the cardiac muscle is contracted). AMI was defined as the combination of elevated circulating levels of cardiac biomarkers — either troponin or creatine kinase and its MB isoenzyme — with typical chest pain lasting for at least 30 min or typical electrocardiogram changes. None of the study’s participants were admitted to the hospital in the 3 months prior to the study and none of the patients died in either the control or AMI group.

The study evaluated the prevalence of diabetes, hypertension, smoking and family history of coronary artery disease — all risk factors for AMI — between the control and AMI group, but failed to find a difference. However, the AMI group had more cholesterol problems. The researchers found that hair cortisol concentrations in the proximal 3-cm segments of the AMI patients, which corresponds to the last three months, were significantly higher that those of controls. When they looked closer at the AMI patient samples, they were unable to find a difference between hair cortisol levels in the first 1.5-cm and second 1.5-cm segments. When the entire study population (a combination of both control and AMI patients) was divided into quartiles (i.e. dividing the data set into four equal parts so that each part represents one-fourth of the sampled population), the occurrence of AMI increased with hair cortisol concentration (see figure).

The scientists then conducted an analysis using multivariate logistic regression. Logistic regression is a statistical model used for prediction of the probability of occurrence of an event, using predictor variables that may be either numerical or categorical. Their model included factors known to affect the risk for AMI, including age, LDL and HDL cholesterol, BMI, smoking status, previous myocardial infarction, and log-transformed hair cortisol. Only hair cortisol concentrations correlated with AMI.

There are several limitations with this study. First, the analysis only evaluated male patients. AMI is more prevalent in men than women and as there are hormonal differences between men and women, the results should not be applied to females. Second, the study population was small and will need to be corroborated in larger studies. Third, there are limitations to the measurement of cortisol in hair, including length, contamination, and affects of environmental, ethnic and nutritional factors. The researchers also suggest that AMI may be preceded by an escalating restriction in blood supply in the days to weeks prior to a heart attack and thus may have caused stress (rather than stress causing a heart attack). However, the finding that the level of hair cortisol in AMI patients was not statistically different between the first and second 1.5-cm, corresponding to the months leading up to a heart attack, supports the view that hair cortisol levels are a marker of chronic rather than acute stress. Fourth, the study did not consider psychosocial stress nor whether the stress was of physical or emotional nature. Lastly, the study does not address the question of whether, within the group of patients at high risk for a heart attack, the degree of stress would be associated with an increased risk to actually develop a heart attack.

Drs. Gideon Koren and Stan Van Uum — senior authors of the study — developed the method to measure cortisol levels in hair. According to Koren [7]:

Intuitively we know stress is not good for you, but it’s not easy to measure. We know that on average, hair grows one centimetre (cm) a month, and so if we take a hair sample six cm long, we can determine stress levels for six months by measuring the cortisol level in the hair. Stress is a serious part of modern life affecting many areas of health and life. This study has implications for research and for practice, as stress can be managed with lifestyle changes and psychotherapy.

This study demonstrates a novel technique to quantify the accumulation of cortisol in hair over time and suggests that hair cortisol can be used as a biomarker for chronic stress. This study further suggests that cortisol levels are elevated prior to the clinical manifestation of coronary heart disease, supporting the theory that chronic, long-term stress is not healthy and may result in the increased risk for coronary artery disease.

References

1. Rosengren et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004 Sep 11-17;364(9438):953-62.
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2. Aboa-Eboule et al. Job strain and risk of acute recurrent coronary heart disease events. JAMA. 2007 Oct 10;298(14):1652-60.
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3. Pereg et al. Hair cortisol and the risk for acute myocardial infarction in adult men. Stress. 2010 Sep 2. [Epub ahead of print]
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4. Steptoe et al. Effort-reward imbalance, overcommitment, and measures of cortisol and blood pressure over the working day. Psychosom Med. 2004 May-Jun;66(3):323-9.
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5. Reynolds et al. Elevated fasting plasma cortisol is associated with ischemic heart disease and its risk factors in people with type 2 diabetes: the Edinburgh type 2 diabetes study. J Clin Endocrinol Metab. 2010 Apr;95(4):1602-8. Epub 2010 Feb 3.
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6. Kalra et al. The relationship between stress and hair cortisol in healthy pregnant women. Clin Invest Med. 2007;30(2):E103-7.
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7. Hair provides proof of the link between chronic stress and heart attack. Western News press release, The University of Western Ontario. 2010 Sep 3.

Have you ever heard a person in poor health being told “Well, you’ve got to stay positive, that will help”? This seemingly common idea is currently under significant scientific investigation. Indeed, the debate about the degree to which psychological processes can directly influence physical health has received special attention recently. A special supplement of the Annals of Behavioural Medicine directly addressed this topic in February this year and a recent article in the Lancet explored this issue, cautioning us that the relationship between a positive psychological orientation and cancer survival remains unclear [1].

Linking the nervous system to the immune system

In a previous article, I discussed the direct and indirect links between beliefs about illness and physical health for people with heart disorders. What we did not consider however was how this direct influence may be happening. Enter “Psychoneuroimmunology” – the field of study exploring the direct link between the nervous system and immune system, including the endocrine system, covering hormones. The brain controls these systems. Part of psychoneuroimmunology is the study of degree to which the action of these systems is impacted on by mental health and the way we think and process information around us. This is of particular interest when we exam the relationship between psychological experience, nervous/immune/endocrine systems and health conditions.

One health condition much researched in relation to psychoneuroimmunology is cancer, not only because of the enormously high mortality and morbidity rates associated with cancer globally, but also the psychosocial context of cancer. Cancer was historically highly stigmatised with the idea that a cancer-prone personality existed [2]. The concept that one’s personal characteristics were related to the illness lead to the idea that adopting a positive, active personality would be protective. Within modern terms, scientists now investigate the degree to which psychology may directly influence cancer pathology.

Stress and cancer

Let us first look at the biological aspects of stress and cancer. In an opinion article based on a systematic review of the literature, Ondicova and Mravec (2010) explore how the nervous system affects cancer “etiopathogenesis”, or, in plain English, the biomedical cause and development of a disease or health condition [3]. Cortisol is released in response to physical and psychological stress, and appears to reduce immune cell function, which may influence tumour growth. Norepinephrine (also known as noradrenaline) is also released in response to stress when epinephrine (also known as adrenaline) is released. Norepinephrine is implicated in the psychobiology of depression. Norepinephrine has been shown to induce cancerous cell growth in mouse animal model studies [4], but reduce the migratory activity of human ovarian carcinoma cells [5]. However, other elements of the nervous system exist to protect us from stress. For example, prostaglandins, which are thought of as messenger molecules throughout the body, act on a huge variety of cells and processes, including muscle cells, blood cells and hormone regulation. These prostaglandins can actually decrease the number of malignant cells in animals [6]. Ondicova and Mravec state that “cancer can be thought of as a process that overcomes not only the protective mechanisms of the immune system but also the protective influences of the nervous system” [6]. Nevertheless, overall the studies of how biological responses to stress might influence tumour growth provide an unclear picture and there is a clear requirement for further studies to properly understand this issue.

The connection between cancer and psychology

So, then, what has this to do with psychology? Well, the link that has been hotly debated is that of positive psychology and cancer. Positive psychology researches happiness, quality of life and strengths, exploring how to ensure a sense of wellbeing. Research on optimism and benefit finding has suggested that having a positive outlook can influence illness progression and management. Specifically, a recent review article in a special issue exploring positive psychology and cancer considers how positive psychology might influence cancer pathology [7].

The review examines studies that show cortisol could be reduced by benefit-finding among breast cancer patients. Indeed, people who engaged in positive thinking (here self-enhancement and self-affirmation) had lower cardiovascular responses to stress. As such, the potential link between your conscious psychological experience and physical health is outlined. The argument then states that psychological responses to stress affect neuroendocrine and immune functioning, which in turn influence tumour growth. The authors of the review highlight the seemingly large and obvious link between mental health and cancer. Being able to adequately deal with stress should, according to this pathway, help protect us from cancer. However, other authors point to the lack of specific pathway and high quality evidence to support this link [3, 8].

Cognitions leading to stress affect biology

There is clearly a complex relationship between life experiences, cognitions, stress and illness, including cancer. Psychological experiences have a basis in brain chemistry and biology, and it appears that cognitions leading to stress then have an affect on biology. A basic example is that when stressed, we experience muscle tension and increased heart rate. The strength of the relationship between thoughts and pathologies such as cancer cannot yet be determined and as such, results should be viewed with a healthy scepticism. Psychological interventions to improve psychological health, reduce negative thinking, stress and anxiety may be beneficial not only for mental health and quality of life, but also potentially for physical health.

References

1. Ondicova K and Mravec B. Role of nervous system in cancer aetiopathogenesis. Lancet Oncol. 2010 Jun;11(6):596-601.
   View abstract
2. Sontag, S. Illness as Metaphor. New York: Farrar, Straus & Giroux. 1978. ISBN 0-394-72844-0
3. Coyne JC and Tennen H. Positive psychology in cancer care: bad science, exaggerated claims, and unproven medicine. Ann Behav Med. 2010 Feb;39(1):16-26.
   View abstract
4. Sood et al. Adrenergic modulation of focal adhesion kinase protects human ovarian cancer cells from anoikis. J Clin Invest. 2010 May 3;120(5):1515-23. doi: 10.1172/JCI40802. Epub 2010 Apr 12.
   View abstract
5. Bastian et al. The inhibitory effect of norepinephrine on the migration of ES-2 ovarian carcinoma cells involves a Rap1-dependent pathway. Cancer Lett. 2009 Feb 18;274(2):218-24. Epub 2008 Oct 11.
   View abstract
6. Wang D and Dubois RN. Prostaglandins and cancer. Gut. 2006 Jan;55(1):115-22. Epub 2005 Aug 23.
   View abstract
7. Aspinwall LG and Tedeschi RG. The value of positive psychology for health psychology: progress and pitfalls in examining the relation of positive phenomena to health. Ann Behav Med. 2010 Feb;39(1):4-15.
   View abstract
8. Coyne et al. Positive psychology in cancer care: A story line resistant to evidence. Ann Behav Med. 2010 Feb;39(1):35-42.

At this time last year, I announced the Highlight HEALTH Network, a single source that aggregates content from all the Highlight HEALTH websites. This year, I have a similar gift for biomedical and healthcare blogosphere readers:

Health and Medicine blog carnival email and RSS subscriptions!

I’ve set up feeds for a number of credible, rotating health and medicine blog carnivals. Note that blog carnivals such as Radiology Grand Rounds were intentionally omitted because each edition is normally hosted at the same site. Now, if you would like to follow your favorite carnival, you can simply subscribe by email or RSS — each post links directly to the blog hosting the carnival. To subscribe by email or RSS, click on the RSS icon next to each carnival name. If you subscribe to more than one carnival, there’s also an aggregated feed:

Subscribe to the mashup … one subscription, all eight carnivals

Here are the individual blog carnival feeds:

Grand Rounds	Change of Shift	Medicine 2.0
Gene Genie	Encephalon	Cancer Research
SurgeXperiences	Health Wonk Review

With particular thanks to Marshall Kirkpatrick for the idea, I hope the subscription options increase the popularity and readership of each of the respective carnivals. Happy Holidays!

Now, on to the Holiday Edition of Grand Rounds. This issue consists of five sections: The Holiday Season; Biomedical News and Research; Doctors, Nurses, Students and Patients; Advice, Tips and Q&A; and Healthcare. Given the number of great submissions, I’ve intentionally kept my comments brief so that you can focus on the content of each article.

The Holiday Season

Teen Health 411

This holiday season, Dr. Nancy Brown reminds us that assuming we are entitled to anything keeps us from appreciating what we have, writing Gratitude and Holidays!

Doc Gurley

There are many people who can use our help this holiday season. Dr. Jan Gurley explains how we can benefit from giving a gift to a homeless person in The Second Annual Homeless Gift Guide.

Notes of an Anesthesioboist

T helps a colleague manage one of the toughest airways of the year and realizes with gratitude what a dynamic gift good teaching can be. Candy Cane Time

How To Cope With Pain Blog

Lisa Copen offers 12 Gift Ideas for Gals with Chronic Illness such as chronic pain, fibromyalgia and migraine.

moneduloides

For people wishing to buy educational books this season, specifically those with a simple interest in human evolution, Moneduloides makes some recommendations, wishing all of us a A Very, Merry, Human Evolutionary Christmas.

The Fitness Fixer

I have a long drive to the hospital everyday and use the time to stay informed by listening to NPR. Over the holiday season, Dr. Jolie Bookspan suggests something similar: Reducing Holiday Driving Stress and Increasing Human Connection.

AEQUANIMITAS

Dr. Chris Nickson recounts the story of jellyfish hunter Jack Barnes and how he determined the cause of a distressing condition called Irukandji syndrome by stinging himself and his 9 year-old son in December 1964 — some Christmas present! Jack Barnes and the Irukandji Enigma

Canadian Medicine

Alberta National Democratic Party leader Brian Mason isn’t very happy with the Conservative government’s management of healthcare in recent years. Sam Solomon recounts A Carol for Alberta’s Health Minister.

Biomedical News and Research

Clinical Cases and Images

The New England Journal of Medicine (NEJM) Horizons Conference was a 3-day meeting in October 2008 that focused on the future of medical publishing. Dr. Ves Dimov begins a 3-part series reflecting his impressions from each day of the meeting. NEJM Horizons Conference to Push Boundaries of Traditional Medical Publishing, Day 1

Suture for a Living

Dr. Ramona Bates covers the First Face Transplant Done in the U.S.

ACP Internist

A recent study finds that patients get more anxious when doctors use medical terms for conditions and diseases than lay terms [1]. Jessica Berthold warns, Careful What You Say … and How You Say It.

Why am I still here?

Tiny Shrink explores Public Persona and considers the difference publishing a case report in an academic journal or magazine that gets posted to the internet versus posting an anonymous blog, and why one activity is often forbidden but not the other.

Dr Shock

A recent study reported the results of a meta-analysis of experimental studies on Internet addiction published in academic journals from 1996 — 2006, assessing how Internet addiction has been measured and analyzing the degree of association between variables [2]. Dr. Walter W. van den Broek finds Internet Addiction Research Disappointing.

The Neurocritic

While a recent report from the Radiological Society of North America contained several inaccuracies, it nonetheless demonstrated that the potential for cortical plasticity persists at six or more months post-stroke [3]. The Neurocritic sets the record straight on Neuroimaging Studies of Stroke Rehabilitation.

Colorado Health Insurance Insider

A primary care physician (PCP) faces a number of challenges today, including a shortage of doctors and inequitable reimbursement. While it’s well-known in the healthcare and health insurance blog worlds, Louise reports that Most Americans are Unaware of the PCP Shortage.

SharpBrains

Dr. Pascale Michelon describes the cognitive reserve hypothesis, tested in multiple studies, which states that individuals with more cognitive reserve can experience more Alzheimer’s disease pathology in the brain (more plaques and tangles) without developing Alzheimer’s disease symptoms. Education builds Cognitive Reserve for Alzheimers Disease Protection

Mexico Medical Student

Enrico critiques an article written by a psychiatrist that appeared in New England Journal of Medicine and was reported on by the New York Times regarding medical school curricula and how they may be failing at teaching basic introductory communication skills, asking Dr. Manners, I Presume? [4].

Laika’s MedLibLog

One of the things Web 2.0 does is facilitate creativity, information sharing and collaboration among users. Dr. Jacqueline reviews The OpenECGproject: an Admirable Web 2.0 Initiative.

Doctors, Nurses, Students and Patients

other things amanzi

Are surgeons self-confident or arrogant? Bongi reflects on being The Best.

Emergiblog

Doctors and nurses share the same space at work but work in different spaces. After a night on divert, Kim realizes Nurses are from Mars, Doctors are from … Some Other Galaxy.

The Happy Hospitalist

The Happy Hospitalist shares a child’s future endeavors as a physician. When I am 30

monash medical student

After his 3rd year in medical school, Jeffrey Leow has Top 10 “to-dos” Before Graduating from Med School.

DUNCAN CROSS

Duncan Cross reflects on Gifts, specifically the best gift he’s ever gotten and how it has affected his life with illness.

Anatomy on the Beach

Kent Tisher moves Onward, reflecting back on his first two years of medical school, leaving the Caribbean and actually knowing things in the ER.

Own Your Health

Roanne Weisman tells the story of Jacqueline Miller and her journey to recovering in this Story of Hope: “All I Wanted to do was Hug My Children.”

Shrink Rap

Sociopaths, psychopaths and antisocials — Clink asks Who is a Criminal?

Advice, Tips and Q&A

The Back Pain Blog

Dean Moyer responds to a reader’s question about neck pain and the changing weather, sharing some tips on how to deal with winter in a way that can make Neck Pain and the Cold seem a little less daunting.

Medicine for the Outdoors

Exposure to extremely cold external temperatures is a critical issue this time of year. Dr. Paul Auerback offers a Frostbite Update.

Neuroanthropology

Dr. Daniel Lende offers balanced advice on cosleeping, bedsharing and breastfeeding. Cosleeping and Biological Imperatives: Why Human Babies Do Not and Should Not Sleep Alone

Adventure Health Clinic

Finger taping is a technique rock climbers use to prevent injuries or to keep climbing with an injury. Dr. Erik McLaughlin reviews Rock Climbing, Finger Taping and Injury.

Allergy Notes

Dr. Ves Dimov provides a summary of Sesame Food Allergy: Questions and Answers

Healthcare

ScienceRoll

Dr. Berci Meskó focuses on why a bridge is needed between medical professionals and e-patients and how it should be constructed. The Bridge: Do You Want to Change Healthcare?

HealthBlawg

David Harlow reviews a paper assessing the value of a public plan — Medicare-for-all — as an option for coverage under an Obama healthcare reform plan [5]. Jacob Hacker makes the case for public plan choice in national health reform

Medviews

Dr. Stuart Henochowicz expresses his thoughts on what the Obama administration stimulus package should focus on, urging that the government Spend, Spend, Spend on healthcare.

The Covert Rationing Blog

HMOs are staring at the ugly prospect of their one-and-only engine for growth in recent years — Medicare Advantage — being taken away from them in about a month. Dr. Rich considers the implications. The HMO Death Watch, 2: How Shall We Regard Medicare Advantage?

InsureBlog

Is it okay to induce labor if it means the difference between insurance paying and not? What are the limits of Medical Necessity? Bob Vineyard tells the disturbing story.

Health Business Blog

Some people are upset that health insurers and doctors want to participate in the Obama transition’s healthcare house parties. Not David Williams, asking us to Guess who’s coming to dinner?

Conclusion

That concludes the Holiday Edition of Grand Rounds, Vol. 5 No. 14. It’s been great hosting Grand Rounds for the first time and I’d like to thank everyone that submitted articles.

The New Years Edition of Grand Rounds, Vol. 5 No. 15, is being hosted by moneduloides on December 30th.

References

1. Young et al. The role of medical language in changing public perceptions of illness. PLoS ONE. 2008;3(12):e3875. Epub 2008 Dec 8.
   View abstract
2. Byun et al. Internet Addiction: Metasynthesis of 1996-2006 Quantitative Research. Cyberpsychol Behav. 2008 Dec 10. [Epub ahead of print]
   View abstract
3. Robotic Technology Improves Stroke Rehabilitation. Radiological Society of North America press release. 2008 Dec 3.
4. Kahn MW. Etiquette-based medicine. N Engl J Med. 2008 May 8;358(19):1988-9. View abstract
5. Hacker JS. The Case for Public Plan Choice in National Health Reform. Center on Health, Economic & Family Security. University of California Berkeley School of Law. 2008 Dec 16.

Want to reduce your stress level, spend less money at the pump and do your part to help save the planet? Here’s one of the most simple yet effective tips that will accomplish all three: Slow Down.

Improve Your Financial Health: Use Less Gas

At highway speeds, wind resistance increases exponentially and fuel economy is reduced by approximately 4 miles per gallon for every 10 mile per hour increase [1]. Thus, the faster you drive, the more it will cost you. Consider this [1].

In a typical family sedan, every 10 miles per hour you drive over 60 is like the price of gasoline going up about 54 cents a gallon. That figure will be even higher for less fuel-efficient vehicles that go fewer miles on a gallon to start with.

That’s based on a $3.25 price per gallon, which is less than the current price of gas. So we’re talking more than 54 cents a gallon.

Additionally, if you do the math, speeding doesn’t save you anywhere near the time you might think it does. An average 30 mile commute traveling at 65 miles/hour takes 28 minutes, while that same trip at 80 miles/hour takes 23 minutes. You save a whole 5 minutes by driving 15 MPH faster.

How much money is that 5 minutes worth?

Reduce Stress and Stay Safe

Moderate levels of stress from a variety of sources, including other motorists, traffic congestion and roadway conditions, are common in everyday driving. However, driver stress has been shown to also be influenced by a combination of situational and personal factors, including factors external to the driving context [2].

Not surprisingly, studies have found that life stress is associated with higher rates of accidents and disease [3]. It’s been estimated that drivers who have experienced a recent stressful event are five times more likely to cause fatal accidents than unstressed drivers [4].

If you’re running late, remember that no matter how fast you drive, you’re still going to be late. If you’re under a great deal of personal stress, it’s probably best to avoid driving altogether.

Statistically, people who drive too fast cause or contribute to almost one-third of all fatal crashes. In 2006,13,543 lives were lost in speeding-related crashes [5]. Excessive speed does a number of things:

• it increases the distance a vehicle travels when a driver reacts to a dangerous situation
• it reduces a driver’s ability to steer safely around objects in the road
• it extends the distance necessary to stop

Want to reduce your stress level, spend less money on gas and do your part to help save the planet?

Just Slow Down!

David over at The Good Human has some additional tips on saving money, saving fuel and saving the environment.

References

1. Slow down a little, save a lot of gas. Issue #1: America’s Money. CNN Money. 2008 Mar 27.
2. Hennessy et al. The Influence of Traffic Congestion, Daily Hassles, and Trait Stress Susceptibility on State Driver Stress: An Interactive Perspective. Journal of Applied Biobehavioral Research 5(2);162-179
   doi: 10.1111/j.1751-9861.2000.tb00072.x
3. Stuart and Brown. The relationship of stress and coping ability to incidence of diseases and accidents. Journal of Psychosomatic Research, 25(4), 255-260. 1981.
   View abstract
4. Brenner and Selzer. Risk of causing a fatal accident associated with alcoholism, psychopathology, and stress: further analysis of previous data. Behav Sci. 1969 Nov;14(6):490-5.
   View abstract
5. Traffic Safety Facts 2006 Data. National Highway Traffic Safety Administration National Center for Statistics and Analysis. 2006.