Children now are facing an increasing risk of early life stress (ELS), which leads to detrimental psychosocial outcomes. Behavior studies suggested that positive parental interactions might moderate the negative impact of ELS, but the related biological alteration remains unclear. This study aims to investigate whether positive parent-child interactions moderate the association between maltreatment (as a severe form of ELS) and hair cortisol concentration (HCC), as well as between HCC and psychosocial outcomes in young children. Participants were 6-year-old Chinese children (N = 257, Mage = 6.2, 121 were male) selected by stratified cluster random sampling from a Shanghai population representative cohort. Proximal 3 cm hair strands were analyzed using liquid chromatography coupled with tandem mass spectrometry for HCC. Children\'s psychosocial outcome was evaluated using the parental report Strengths and Difficulties Questionnaire (SDQ). Parents also reported the frequency of positive parent-child interactions using the Chinese Parent-Child Interaction Scale (CPCIS) as well as the history of maltreatment. Multi-level logistic regression models adjusting for individual, kindergarten, and district confounders were used to evaluate the associations between maltreatment, HCC, and psychosocial outcomes. Interactions terms tested whether more frequent positive parent-child interactions moderates the association between maltreatment and HCC, as well as between HCC and psychosocial outcomes. Maltreated children exhibited higher levels of HCC (B = 1.20, 95% CI: 0.38,2.02; p = 0.004), and children with higher HCC exhibited poorer psychosocial outcomes (B = 0.34, 95% CI: 0.18,0.51; p < 0.001). Positive parent-child interactions did not have a moderating effect on the association between maltreatment and HCC, but they demonstrated a moderating effect on the association between increased HCC and psychosocial outcomes (interaction term: B = -0.42, 95% CI: -0.75,-0.10; p = 0.01). These findings provide evidence that positive parental interaction may serve as a moderator between chronic cortisol exposure and psychosocial problems. It highlights the importance of frequent parent-child interactions, especially among children under a high risk of ELS.

Tobacco smoking is one of the critical public health threats all over the world. Since nicotine and its metabolite cotinine have been routinely used as the biomarkers to estimate the exposure to tobacco smoking, hair nicotine and cotinine analyses can provide of a retrospective index of nicotine and cotinine integrated over extended periods of several months prior to hair sampling to estimate the long-term exposure to tobacco smoking. Since the relationship between tobacco smoking and hypothalamic-pituitary-adrenal (HPA) axis is implicated in both stress response and nicotine addiction, better understanding of the association between hair nicotine, cotinine levels and hair cortisol, cortisone levels is an important prerequisite toward more adequate use of this method in future research. We here presented an online solid phase extraction (SPE) coupled with liquid chromatography- tandem mass spectrometry (LC-MS/MS) method for quantification of long-term integrated nicotine and cotinine in human hair. This method was applied to the analysis of hair nicotine and cotinine in 40 participants of smokers and nonsmokers (mean ± SD age: 46.25 ± 11.92 years; 40 % male) and the investigation of their association with hair cortisol and cortisone. Methanol together with glass tube was used for hair nicotine and cotinine extraction during the incubation time of 18-h. The limits of quantification were 1 pg/mg for nicotine as well as 0.1 pg/mg for cotinine. The inter- and intra-day coefficients of variation were below 15 %. The method recovery ranged between 90 % and 104 %. Group-level analyses revealed that smokers exhibited higher hair nicotine and cotinine levels compared to nonsmokers. Hair nicotine and cotinine levels showed significant positive associations with hair cortisol and cortisone levels in smokers (nicotine and cortisol: Spearman\'s ρ = 0.619, p = 0.005; cotinine and cortisol: Spearman\'s ρ = 0.468, p = 0.043; nicotine and cortisone: Spearman\'s ρ = 0.773, p = 0.000; cotinine and cortisone: Spearman\'s ρ = 0.531, p = 0.016), but not in nonsmokers. The presented online SPE LC-MS/MS method provides a simply and highly specific analytical strategy for the detection of nicotine and cotinine concentrations in human hair for the retrospective assessment of cumulative long-term nicotine and cotinine exposure. Furthermore, hair nicotine, cotinine levels correlate with hair cortisol, cortisone levels in smokers other than nonsmokers.

BACKGROUND: Existing literature mostly investigated the relationship of acute or short-term glucocorticoid exposure to HIV disease progression using cortisol levels in serum, saliva, or urine. Data are limited on the relationship of long-term glucocorticoid exposure to HIV disease progression. This study examined whether hair glucocorticoid levels, novel retrospective indicators of long-term glucocorticoid exposure, are associated with two common indicators of HIV disease progression (CD4 count and HIV viral load) among a large cohort of combination antiretroviral therapy treated Chinese people living with HIV (PLHIV).
METHODS: A total of 1198 treated PLHIV provided hair samples for glucocorticoid (cortisol and cortisone) assay and completed a survey assessing sociodemographic, lifestyle, and HIV-related characteristics. Meanwhile, CD4 count and HIV viral load were retrieved from their medical records. Spearman correlation was used to examine the associations of hair cortisol and cortisone levels to continuous CD4 count and HIV viral load. Multivariate logistic regression was used to predict CD4 count < 500 cells/mm3.
RESULTS: Both hair cortisol and cortisone levels were negatively associated with CD4 count but not with HIV viral load. The odds ratio for CD4 count < 500 cells/mm3 was 1.41 [95% CI 0.99-2.00] and 2.15 [95% CI 1.51-3.05] for those with hair cortisol and cortisone levels in the highest quartile compared to the lowest when controlling for sociodemographic, lifestyle, HIV-related covariates, and HIV viral load.
CONCLUSIONS: Hair glucocorticoid levels were associated with CD4 count but not viral load in treated Chinese PLHIV. Our data furtherly supported the hypothesis that elevated glucocorticoid levels are associated with the lower CD4 count.

Stress plays an important role in the pathogenesis of depression through functional changes to the hypothalamic-pituitary-adrenal (HPA) axis, a key output of which is the stress hormone cortisol. But the precise relationship between HPA axis activity and depression remains unclear, in part because mostly cortisol measurement only provides reflect acute or short-term fluctuations. In this study, hair cortisol and its metabolite cortisone were measured in a prospective, pre and post follow-up study of working stress and depressive symptoms in Chinese fishermen. We evaluated HPA activity, work stress, and depression symptoms before and after fishing to determine whether cortisol and cortisone in hair can moderate the work stress and depression symptoms of Chinese fishermen.
Hair cortisol, hair cortisone, work stress, and depression were measured in Chinese fishermen (n=229; age 16-65) before and after 1-3 months at sea. A week after the fishermen returned, they provided 2-4 cm hair segments closest to the scalp. We measured hair cortisol and hair cortisone using high-performance liquid chromatography-tandem mass spectrometry.
The work stress and hair cortisol of fishermen before fishing were significantly higher than those after fishing, while hair cortisone was lower. There was no significant difference in depressive symptoms. Fishermen with low hair cortisol or high hair cortisone were more likely to show depressive symptoms after experiencing stress, and were less likely to show depressive symptoms when faced with lower levels of work stress, consistent with the differential susceptibility model.
The assumption of an average hair growth of 1 cm/month may cause time overlap between pre- and post-fishing, and time error between the hormone data and questionnaire collection. The present study evaluated only two observation points. The use of self-report scales may affect interpretability of the results. Finally, the study used a limited sample of marine fishermen working out of a single location in Hainan province, China.
Hair cortisol and hair cortisone appear to have a moderating role in the relationship between work stress and depressive symptoms among fishermen, which fits with the differential susceptibility model of depression. However, their mechanisms of moderation are not the same, which may reflect the complexity of physiological indicators.

Cumulative evidence to date largely supports an association between dysregulation of the activity of the hypothalamic-pituitary-adrenal (HPA) axis and fatigue. People living with HIV (PLHIV), in particular, are vulnerable to both HPA axis dysregulation and fatigue. Few investigations have examined the possible role of HPA-axis dysfunction in the occurrence of fatigue in PLHIV. This cross-sectional study aimed to investigate the association between glucocorticoids in hair, retrospective indicators of long-term HPA axis activity and biomarkers of chronic stress, and fatigue in PLHIV. A total of 446 PLHIV from Guangxi China provided hair samples for cortisol and cortisone assay and provided information on fatigue levels, sociodemographic, lifestyle, and HIV-related characteristics. Results showed that before and after controlling sociodemographic, lifestyle, and HIV-related characteristics, hair cortisone levels, but not hair cortisol levels, were associated with fatigue levels in PLHIV. In conclusion, we found that higher cortisone levels are associated with greater fatigue levels in a large cohort of Chinese PLHIV.LAY SUMMARYWe found that hair cortisone levels were significantly associated with fatigue levels in a large cohort of Chinese PLHIV. Hair cortisol levels were, however, not associated with fatigue levels in the PLHIV studied. We thus show that Chinese PLHIV who have higher cortisone levels are associated with higher fatigue levels.

Chronic stress is a risk factor for a variety of physiological disorders because of its increased activation of the hypothalamic-pituitary-adrenal (HPA) axis; however, it is difficult to reveal environmental and genetic effects contributing to long-term HPA activity because of the complexity of chronic stress. The hair cortisol concentration (HCC) can be used to reflect the accumulation of HPA axis activity over time. Some studies suggest that the HCC might be associated with the protein concentration (PC) in the hair shaft; however, no studies have revealed a dynamic relationship between them. In the present study, 1,086 hair samples from 418 Holstein cows were collected, and the effects of environmental factors on HCC, PC, and ratio of HCC to PC (HCCP) were studied. Subsequently, regression analysis and curve fitting were used to identify for better-performing indicators of chronic stress. Additionally, univariate and bivariate genetic evaluation were used to estimate the genetic components of cortisol traits and genotype by environment interactions (G × E) under different environmental and physiological states. The results showed that HCC and PC are significantly affected by hair color, sampling year, and season, whereas HCCP is not influenced by hair color. Adjusted PC and HCCP, where confounding effects are excluded, were moderately related with chronic stress indicators. Moderate to high heritabilities were obtained for HCC (0.347 and 0.390 for winter and summer, respectively), PC (0.402 and 0.495 for winter and summer, respectively) and HCCP (0.289 and 0.460 for winter and summer, respectively) when animals in the same season were evaluated. A moderate G × E interaction was detected in this study, as indicated by the low or negative genetic correlation for the same cortisol trait in different environments (e.g. heat stress condition and thermoneutral condition). In conclusion, HCCP is not affected by hair color compared with the other 2 traits; thus, it has potential as an indicator of chronic stress. Hair cortisol traits could monitor stress response process in cattle, as well as provide a better understanding of genetic mechanism for long-term HPA activity.

UNASSIGNED: Pain is a common occurrence and persistent symptom, which has an adverse impact on individual well-being and quality of life among people living with HIV (PLHIV). Alteration in the activity of the Hypothalamic-Pituitary-Adrenal (HPA) axis resulting in abnormal glucocorticoid levels had been proposed to play important roles in those associations.
UNASSIGNED: This study aimed to investigate whether pain severity was associated with hair glucocorticoid levels, a novel method of measuring long-term glucocorticoid exposure, among a large cohort of Chinese PLHIV.
UNASSIGNED: A measure of pain severity and hair samples were collected from 431 adults PLHIV in Guangxi, China. Glucocorticoid (cortisol and cortisone) in hair were quantified by liquid chromatography-tandem mass spectrometry. The general linear model was used to test the associations of pain severity with hair glucocorticoid levels after adjusting for potential confounding factors.
UNASSIGNED: Of the 431 PLHIV, 273 reported none pain, 87 reported mild pain, and 71 reported moderate-severe pain. Hair cortisone, but not hair cortisol, was found to differ significantly among the three pain severity groups (F=3.90, p=0.021). PLHIV reported moderate-severe pain had higher hair cortisone than those reported mild (p=0.070) or none pain (p=0.014), with no differences between the latter two pain severity groups.
UNASSIGNED: Greater pain severity is associated with higher hair cortisone levels among Chinese PLHIV. In order to reduce the long-term glucocorticoid levels, interventions managing pain should be considered for PLHIV with moderate-severe pain.

OBJECTIVE: Major depressive disorder is associated with abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis. Studies using hair cortisol to measure the effect of antidepressants on the HPA axis are lacking. The aim of this study was to explore the long-term effects of antidepressants on hair cortisol concentration (HCC).
METHODS: Participants were 42 patients and 36 healthy individuals. The patients took antidepressants for 4 weeks. Patient HCC was measured pre-treatment and post-treatment. The HCC of healthy controls was also measured.
RESULTS: Patient post-treatment HCC (mean ± standard deviation: 34.40 ± 32.57 pmol/mg) was significantly higher than patient pre-treatment HCC (17.42 ± 12.40 pmol/mg) and healthy control HCC (10.22 ± 7.99 pmol/mg). No significant correlation was found between Hamilton Depression Rating Scale scores and HCC at pre-treatment or post-treatment.
CONCLUSIONS: Hair cortisol concentration analysis could be used to monitor the dynamics of the effects of antidepressants on the HPA axis.

Major depressive disorder (MDD), commonly known as depression, is a mental disease characterized by a core symptom of low mood. It lasts at least two weeks (Badamasi et al., 2019; Wang et al., 2019) and is frequently accompanied by low self-esteem, loss of interest in routinely enjoyable activities, low energy, and unexplained pain (Huey et al., 2018; Park et al., 2012; Post & Warden, 2018; Rice et al., 2019; Xiao et al., 2018). Approximately 2%-8% of adults with MDD commit suicide (Richards & O\'Hara, 2014; Strakowski & Nelson, 2015), and around half of suicidal individuals suffer depression or other mood disorders (Bachmann, 2018).

The present study was designed to clarify the mutual association of job burnout and insomnia and to detect the mediating effects of hair cortisol on that association.
In all, 68 female employees were recruited for the study from one secondary and one tertiary hospital between October 2018 and November 2018 in Beijing. Participants completed a questionnaire for the collection of demographic data and standardized measures for burnout and insomnia. Hair sample collection and anthropometric measurements were performed at the same time.
Median hair cortisol concentration (HCC) was 5.89 ng/g hair (interquartile range = 2.20-10.74). And ages are between 22 and 51 years old (32.50 ± 6.13), among which 22 were below 30 years, 20 were between 30 and 35 years, and 26 were over 35 years. A majority of Pearson\'s coefficients were significant, with the exception of that for the correlation between personal accomplishment and HCC or depersonalization. Significant mutual correlations were shown between burnout dimensions and insomnia directly. HCC acted as a mediator in the pathway from emotional exhaustion, depersonalization to insomnia; and no significant mediating effect of HCC in the pathway from insomnia to burnout was found.
Job burnout may directly or indirectly (through chronically elevated cortisol) increase insomnia risk, whereas insomnia probably promotes burnout. Prospective studies involving different body systems and a larger sample size should be performed to further identify the mechanisms underlying the associations between burnout and insomnia among the working population.