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Background Hematopoietic stem cell transplantation (HSCT) is an aggressive medical procedure which significantly impacts the shared emotional well-being of patients and family caregivers (FC). Prior work has highlighted the significant overlap in well-being among patients and FCs; however, how this interdependence may change over the course of HSCT has received less attention. Methods We conducted secondary analyses of a supportive intervention delivered to 154 FCs of HSCT patients and examined relationships at baseline, 6 weeks, 3 and 6 months post-HSCT. Actor Partner Interdependence Modeling examined patient quality of life (QOL) and FC anxiety/depression. Results The data did not fit a multigroup approach limiting our ability to test intervention effects; however, bivariate analyses indicated FC depression significantly correlated to patient QOL at baseline (r = − .32), 6 weeks (r = − .22) and 6 months post-HSCT (r = − .34; p’s p’s lower FC depression at 3-months (B = .193; p = .026) and changed direction with patient QOL at 3-months being related to more FC depression at 6-months (B = − .187; p = .001). Conclusions These findings highlight the significant, yet nuanced, interdependence of patient QOL and FC well-being during HSCT. Specifically, greater interdependence was observed between patient QOL and FC depression compared to FC anxiety, suggesting potential treatment targets for patients and their families. Trial was registered at ClinicalTrials.gov Identifier: NCT02037568; first registered: January 16, 2014; https://clinicaltrials.gov/ct2/show/NCT02037568

Background: Adolescence is a common time for experimentation with substance use and the emergence of sex differences in substance use patterns. Although similar in early adolescence, male and female substance use patterns historically diverge by young adulthood, with males using more substances than females. We aim to add to current literature by utilizing a nationally representative sample, assessing a broad range of substances used, and focusing on a sentinel period during which sex differences emerge. We hypothesized that certain sex-specific substance use patterns emerge in adolescence. Methods: Data are from the 2019 Youth Risk Behavior Survey (n = 13,677), a nationally representative sample of high school students. Weighted logistic analyses of covariance adjusting for race/ethnicity evaluated males’ and females’ substance use (14 outcomes) by age category. Results: Among all adolescents, more males reported illicit substance use and cigarette smoking than females, whereas more females reported prescription opioid misuse, synthetic cannabis use, recent alcohol use, and binge drinking. Divergence between male and female use usually occurred at 18+ years. Odds of using most illicit substances were significantly greater among males than females at age 18+ years (aORs 1.7–4.47). Among 18+ year-olds, males and females did not differ in electronic vapor product use, alcohol use, binge drinking, cannabis use, synthetic cannabis use, cigarette smoking, or prescription opioid misuse. Conclusions: Sex differences in adolescent use of most but not all substances emerge by age 18+ years. Sex-specific patterns of adolescent substance use may inform specific prevention efforts and identify peak ages for intervention.

PURPOSE: Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a demanding treatment that requires caregiver support during the first 100 days post-transplant. Little is known about the association between caregivers’ employment changes and their well-being during this lengthy and challenging time when caregivers may be balancing work with caregiving responsibilities. METHODS: We used data from employed caregivers of Allo-HSCT patients who participated in two randomized clinical trials (N = 187) of an intervention for caregivers. Caregiver depression and anxiety were assessed using the Center for Epidemiologic Studies Depression and the Spielberger State-Trait Anxiety Inventory. ANCOVA was used to measure the associations between reducing work with depression and anxiety. Caregiver’s demographics and baseline employment status were controlled in the analysis along with the patient’s transplant conditioning intensity. RESULTS: Approximately 45% of caregivers reduced hours worked following the resumption of their caregiving duties. These caregivers, on average, had 3.49 points higher depression scores than caregivers who did not report a reduction in work (p < 0.01). Similarly, these caregivers also reported, on average, 3.56 higher anxiety scores (p < 0.10). CONCLUSIONS: Caregivers who reduced hours worked while caregiving reported greater distress. The underlying cause of this distress deserves further investigation. IMPLICATIONS FOR CANCER SURVIVORS: Caregivers of patients diagnosed with cancer may experience considerable stress related to work discontinuation and caregiving. Interventions are needed to support caregivers who are trying to balance work and caregiving responsibilities.

OBJECTIVE: Caregiving for hematopoietic stem cell transplant (HSCT) patients is associated with significant physical and psychological sequelae. While psychosocial interventions may reduce caregiver burden, knowledge regarding which caregivers may benefit the most from such interventions is limited. The purpose of this secondary analysis was to examine whether HSCT caregivers’ peritransplant sleep moderated the effect of a psychosocial intervention on depression and anxiety posttransplant. METHODS: Participants included 135 caregivers (mean age = 54.23) who participated in randomized controlled trial and were assigned to receive either 8 weeks of Psychoeducation, Paced Respiration, and Relaxation (PEPRR) or treatment as usual (TAU). Sleep, depression, and anxiety were assessed using the Pittsburg Sleep Quality Index, the Center for Epidemiologic Studies Depression Scale, and the State-Trait Anxiety Inventory, respectively. Caregiver symptoms were assessed at baseline (e.g., peritransplant period) and 6-month posttransplant. RESULTS: Baseline sleep quality (ΔR(2) = 0.04, p = 0.002), sleep efficiency (ΔR(2) = 0.03, p = 0.02), and sleep onset latency (ΔR(2) = 0.07, p < 0.001) independently moderated the effect of group assignment on depression outcomes at the 6-month follow-up. Specifically, caregivers with poor sleep at baseline who received PEPRR reported significantly lower depression scores at follow-up compared to caregivers with poor sleep who received TAU. By contrast, only sleep quality (ΔR(2) = 0.02, p = 0.01) and sleep onset latency (ΔR(2) = 0.02, p = 0.005) moderated the effect of the group assignment on anxiety. CONCLUSIONS: Psychosocial interventions for HSCT caregivers may buffer against psychological morbidity, particularly among caregivers with poor sleep quality.

Children with medical complexity (CMC) and their caregivers are at increased risk for multiple psychosocial stressors that can impact child and family well-being and health outcomes. During the COVID-19 pandemic, when access to supports diminished, psychosocial screening and integrated behavioral health (IBH) services in the primary care setting were crucial in identifying and addressing the unique needs of this population METHODS: Universal screening to identify psychosocial needs was implemented in a primary care clinic for CMC that includes IBH services. Data on the prevalence of psychosocial screening and IBH services for young children and their caregivers before and during the COVID-19 pandemic were evaluated RESULTS: Psychosocial screening levels remained stable during the pandemic. Psychosocial needs were identified for 36% of screeners prior to the COVID-19 pandemic and 33% during the COVID-19 pandemic. The need for IBH services increased during the COVID-19 time period resulting in a significant increase in IBH services CONCLUSIONS: For CMC and their caregivers, psychosocial needs identified through psychosocial screening remained high during the pandemic, demonstrating the importance of screening for this population. The need for IBH services during the COVID-19 pandemic increased, underscoring the value and demand for these services particularly during an unprecedented time.Objetivo: Los niños con complejidades médicas (CMC) y quienes les cuidan están bajo un riesgo en aumento sobre múltiples factores sicosociales de estrés que pueden causar impacto en el bienestar y resultados de salud del niño y la familia. Durante la pandemia COVID-19, cuando disminuyó el acceso al apoyo, los servicios de detección sicosocial y la integrada salud del comportamiento (IBH) en escenarios de cuidado primario fueron cruciales para identificar y manejar las necesidades típicas de esta población. Métodos: La detección universal para identificar necesidades sicosociales se implementó en una clínica de cuidado primario para CMC que incluye servicios IBH. Se evaluó la información acerca de la prevalencia de los servicios de la detección sicosocial e IBH para niños pequeños y quienes les cuidaban antes y durante la pandemia COVID-19. Resultados: Los niveles de detección sicosocial se mantuvieron estables durante la pandemia. Se identificaron las necesidades sicosociales para el 36% de los examinados antes de la pandemia del COVID-19 y 33% durante la pandemia COVID-19. La necesidad de servicios IBH aumentó durante el período de tiempo del COVID-19, lo cual resultó en un aumento significativo en servicios IBH. Conclusiones: Para niños CMC y quienes les cuidan, las necesidades sicosociales identificadas a través de la detección sicosocial se mantuvieron altas durante la pandemia, lo que demuestra lo importante de la detección para este grupo de población. La necesidad de servicios IBH durante la pandemia COVID-19 aumentó, subrayando el valor y demanda de estos servicios en particular durante un momento sin precedente.Objectif: Les Enfants avec une Complexité Médicale (abrégé ici en français ECM) et les personnes qui prennent soin d'eux sont à un risque plus élevé de facteurs de stress psychosociaux multiples qui peuvent impacter le bien-être de l'enfant et de la famille ainsi que la santé. Durant la pandémie du COVID-19, lorsque l'accès aux soutiens a diminué le dépistage psychosocial et les services de santé comportementale intégrée (SCI) dans les contextes de soins primaires se sont avérés cruciaux pour l'identification et la prise en charge des besoins uniques de cette population. Méthodes: Le dépistage universel afin d'identifier les besoins psychosociaux a été mis en place dans une clinique de soin primaire pour les ECM qui comporte des services SCI. Les données sur la prévalence du dépistage psychosocial et les services SCI pour les jeunes enfants et les personnes prenant soin d'eux avant et après la pandémie du COVID-19 ont été évalués. Résultats: Les niveaux de dépistage psychosocial sont restés stables durant la pandémie. Des besoins psychosociaux ont été identifiés pour 36% des dépistés avant la pandémie du COVID-19 et 33% durant la pandémie du COVID-19. Le besoin de services SCI a augmenté durant la période, résultant en une augmentation importante des services SCI. Conclusions: Pour les ECM et les personnes prenant soin d'eux, les besoins psychosociaux identifiés à travers le dépistage psychosocial est resté élevé pendant la pandémie, démontrant l'importance du dépistage pour cette population. Le besoin de services SCI durant la pandémie du COVID-19 a augmenté, ce qui souligne la valeur et le besoin de ces services surtout durant ces temps sans précédents.Erhöhte verhaltensmedizinische gesundheitliche Bedürfnisse und anhaltender psychosozialer Stress bei Kindern in medizinisch komplexen Versorgungsstrukturen und ihren Familien während der COVID-19-Pandemie Zusammenfassung: Ziel: Kinder mit komplexen medizinischen Problemen (Children with medical complexity; CMC) und ihre Betreuer:innen haben ein erhöhtes Risiko für verschiedene psychosoziale Stressfaktoren, die sowohl das Wohlbefinden der Kinder und ihrer Familien als auch die gesundheitlichen Folgen beeinträchtigen können. Während der COVID-19-Pandemie, als der Zugang zu Unterstützungsmaßnahmen eingeschränkt war, waren psychosoziale Untersuchungen und integrierte verhaltensmedizinische Gesundheitsleistungen (integrated behavioral health; IBH) in der Primärversorgung von entscheidender Bedeutung, um die besonderen Bedürfnisse dieser Bevölkerungsgruppe zu erkennen und zu erfüllen. Methoden: In einer Primärversorgungsklinik für CMC, die auch IBH-Dienste anbietet, wurde ein universelles Screening zur Ermittlung psychosozialer Bedürfnisse eingeführt. Daten zur Prävalenz von psychosozialen Screenings und IBH-Diensten für Kleinkinder und ihre Betreuer:innen vor und während der COVID-19-Pandemie wurden ausgewertet. Ergebnisse: Das Niveau der psychosozialen Screenings blieb während der Pandemie stabil. Psychosoziale Bedürfnisse wurden vor der COVID-19-Pandemie bei 36 % und während der COVID-19-Pandemie bei 33 % der Screenings festgestellt. Der Bedarf an IBH-Leistungen stieg während des COVID-19-Zeitraums an, was zu einer deutlichen Zunahme der IBH-Leistungen führte. Fazit: Die psychosozialen Bedürfnisse von CMC und ihren Betreuer:innen, die im Rahmen des psychosozialen Screenings ermittelt wurden, blieben während der Pandemie hoch, was zeigt, wie wichtig das Screening für diese Bevölkerungsgruppe ist. Der Bedarf an IBH-Leistungen nahm während der COVID-19-Pandemie zu, was den Wert und die Nachfrage nach diesen Diensten unterstreicht, insbesondere in solch einer nie dagewesenen Situation.COVID-19パンデミックの中の、複雑な病状を持つ子どもたちとその家族の、行動保健ニーズの高まりと継続する心理社会的ストレス 目的: 複雑な病状を持つ子どもたち (CMC) とその保護者は、子どもと家族の幸福や健康に影響を及ぼす多重の心理社会的ストレス要因のリスクが高まっている。COVID-19パンデミックの中、支援サービスの利用が減少する中では、この集団の固有のニーズを特定し対処する上で、プライマリケアにおける心理社会的スクリーニングと統合的行動保健 (IBH) サービスが不可欠であった。方法: 心理社会的なニーズを特定するための全般的なスクリーニングを、IBHサービスを含むCMCのプライマリケアクリニックで行った。COVID-19パンデミックの発生前後で、幼い子どもとその保護者に対する心理社会的スクリーニングとIBHサービスの普及率に関するデータを評価した。結果: 心理社会的スクリーニングのレベルは、COVID-19パンデミックの間、安定していた。心理社会的ニーズが確認されたのは, COVID-19パンデミック前はスクリーニングを行った人の36%, パンデミック中は 33%であった.IBHサービスの必要性はCOVID-19の期間中に増加し、その結果、IBHサービスが大幅に増加した。結論: CMCとその保護者について、心理社会的スクリーニングで特定された心理社会的ニーズはパンデミック中高いままであり、この集団に対するスクリーニングの重要性が示された。また、COVID-19パンデミック中にはIBHサービスの必要性が高まり、特に未曾有の大流行時にはこれらのサービスの価値と需要が高まることが強調された。.研究目的:患有复杂疾病的儿童 (CMC) 及其看护者面临多种心理社会应激源的风险增加, 这些应激源会影响儿童和家庭的幸福以及健康状况。在COVID-19大流行期间, 当获得支持的机会减少时, 初级保健机构中的心理社会筛查和综合行为健康 (IBH) 服务对于识别和解决这类人群的独特需求至关重要。 研究方法:在一家提供IBH服务的CMC初级保健诊所实施了普遍筛查, 以确定心理社会需求。评估了在COVID-19大流行之前和期间为幼儿及其看护者提供心理社会筛查和IBH服务的流行率数据。 研究结果:在大流行期间, 心理社会筛查水平保持稳定。在COVID-19大流行之前, 36%的筛查者确定了心理社会需求;在COVID-19大流行期间, 33%的筛查者确定了心理社会需求。在COVID-19期间, 对IBH服务的需求增加, 导致了IBH服务量显著增加。 研究结论:对于CMC及其看护者而言, 在大流行期间, 通过心理社会筛查确定的心理社会需求仍然很高, 这表明了对这类人群进行筛查的重要性。在COVID-19大流行期间, 对IBH服务的需求量增加, 这突显了在前所未有的时期这类服务的价值和需求。.زيادة الاحتياجات الصحية السلوكية والضغط النفسي الاجتماعي المستمر بين الأطفال الذين يعانون من تعقيدات طبية وأسرهم خلال جائحة كوفيد-19 الهدف: الأطفال الذين يعانون من تعقيدات طبية(CMC) والقائمين على رعايتهم معرضون بشكل متزايد لخطر الضغوطات النفسية والاجتماعية المتعددة التي يمكن أن تؤثر على رفاهية الطفل والأسرة والنتائج الصحية. خلال جائحة كوفيد- 19 ، عندما تضاءل الوصول إلى الدعم ، كان الفحص النفسي الاجتماعي وخدمات الصحة السلوكية المتكاملة (IBH) في بيئة الرعاية الأولية مسائل حيوية في تحديد الاحتياجات الفريدة لهذه الفئة من السكان ومعالجتها. طريقة البحث: تم تنفيذ الفحص في عيادة رعاية أولية للأطفال ذوي التعقيدات الطبية والتي تتضمن خدمات الصحة السلوكية المتكاملة و تم تقييم البيانات المتعلقة بانتشار الفحص النفسي والاجتماعي وخدماتIBH للأطفال الصغار ومقدمي الرعاية لهم قبل وأثناء جائحة كوفيد-19. النتائج: ظلت مستويات الفحص النفسي والاجتماعي مستقرة خلال الجائحة. وتم تحديد الاحتياجات النفسية والاجتماعية لـ 36٪ من الفاحصين قبل جائحة كوفيد-19 و 33٪ خلالها . زادت الحاجة إلى خدماتIBH خلال الفترة الزمنية للجائحة مما أدى إلى زيادة كبيرة في هذه الخدمات. الاستنتاجات: بالنسبة للأطفال ذوى التعقيدات الطبية والقائمين على رعايتهم ، ظلت الاحتياجات النفسية والاجتماعية المحددة من خلال الفحص النفسي والاجتماعي مرتفعة خلال الوباء ، مما يدل على أهمية الفحص لهذه الفئة من السكان. زادت الحاجة إلى خدمات (IBH) أثناء الوباء ، مما يؤكد على قيمة هذه الخدمات وزيادة الطلب عليها خاصة خلال فترة غير مسبوقة.

In the United States, alcohol use disorder adversely affects 5.6% of all adults. Excessive alcohol consumption adversely affects organ functions critical for adaptation to stress induced by surgery. Colorectal resection is one of the most common major surgeries in patients at risk for alcohol use disorder. The objective of this study was to assess the impact of alcohol use disorder on hospital outcomes after colectomy using a population-based discharge database.Population-based discharge database.The Premier Healthcare Database was queried for the 603,730 adult patients who underwent colectomy from 2016 to 2019.None.Multiple logistic regressions estimated the associations between in-hospital mortality, length of stay, and hospitalization cost with alcohol use disorder as the primary predictor, adjusting for other substance use disorders, psychotic disorders, depression, other Elixhauser comorbidities, age, payor, race, gender, non-elective surgery, and other unbalanced variables.A discharge code for alcohol use disorder was identified in 2.9% of colectomy patients and the overall in-hospital mortality rate in all sampled colectomy patients was 1.4%. Alcohol use disorder was associated with a significantly increased risk of in-hospital mortality after adjusting for other factors (AOR 1.36, 95% CI 1.24-1.48, p 0.0001). Alcohol use disorder was also significantly associated with long length of stay (AOR 1.45, 95% CI 1.39-1.52, p 0.0001) and high hospitalization costs (AOR 1.63, 95% CI 1.56-1.70, p 0.0001).Alcohol use disorder is associated with an increased risk of in-hospital mortality in patients undergoing colectomy, one of the most common major surgeries. Future research should examine if enhanced efforts to identify patients with alcohol use disorder could enable anesthesiologists to provide worthwhile perioperative interventions for this high-risk population.

Background Psychological interventions reduce caregiver distress (CG-distress). Less distress in caregivers may contribute to improved patient quality of life (QoL), but empirical evidence is lacking. Will a caregiver stress management intervention improve patient QoL? Methods In this replication study, we randomized 155 allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients and caregivers to PsychoEducation, Paced Respiration, and Relaxation (PEPRR) or enhanced treatment as usual (eTAU). We provided PEPRR over 3 months following transplant. Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) evaluated patient QoL, and CG-distress was based on depressive, anxious, and stress symptoms. Hierarchical linear models tested intervention, time, and interactions as fixed effects with participant as random effects. Results Patients whose caregivers received PEPRR did not differ on FACT-BMT between baseline and 6 months (mean = +3.74; 95% CI, -3.54 to 11.02) compared with patients of caregivers in eTAU (mean = +3.16; 95% CI, -2.88 to 9.20) even though CG-distress was decreased by PEPRR (mean = -0.23; 95% CI, -0.448 to -0.010) compared with those receiving eTAU (mean = +0.27; 95% CI, 0.033-0.504) at 6 months. Conclusions PEPRR reduced CG-distress without affecting their patient's FACT-BMT score. The FACT-BMT may not have distinguished unique psychological changes associated with their caregiver receiving PEPRR.

Sex differences in non-epileptic seizures (NES) are of interest, as the diagnosis is more frequent in women than men (3:1 ratio). This paper reviews clinical findings regarding sex differences in NES through selective literature review and compares coping measures between women and men in our NES clinic. Some distinguishing clinical features of NES in women and men are reported in the literature. However, we found few sex differences in demographics and coping. In our population, avoidance and dissociation were strongly related to one another and significantly related to co-occurring PTSD diagnosis, which was seen in over 50% in both sexes. Our findings confirm a high prevalence of PTSD in patients with NES, suggesting that comorbid PTSD may override sex differences in accounting for use of avoidant and dissociative coping. These findings raise the possibility that NES may, at times, represent an extreme variant in dysfunctional coping in patients with PTSD.

PURPOSE: Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a demanding treatment requiring caregiver support. The pre-transplant period is particularly stressful. How patient and caregiver dyads respond to these stressors can impact post-transplant outcomes. The purpose of this cross-sectional study was to assess pre-transplant patient and caregiver distress, patient quality of life (pQoL), and and simultaneously investigate relationship between caregiver distress, patient distress and patient QoL. METHODS: We measured caregiver anxiety, depressive symptoms, perceived stress, sleep quality, caregiver burden and pQoL in148 dyads compared to clinical thresholds or population norms. To reduce comparisons, we created a composite distress score from affective measures. Associations within dyads were examined via correlation and path analysis. RESULTS: Most dyads scored above norms for psychological measures. Patient distress was positively associated with caregiver distress. Higher caregiver distress significantly predicted poorer pQoL after accounting for the interdependence of patient and caregiver distress. Specifically, patients’ physical functioning was the primary driver of this interrelationship. CONCLUSIONS: Allo-HSCT patients and their caregivers reported elevated distress pre-transplant. Both patient and caregiver distress contributed to pQoL, with patients’ physical functioning accounting significantly for caregiver well-being. Supporting the patient-caregiver dyad before transplantation is a priority for supportive services.

Few studies have addressed whether stress-associated physiological changes in caregivers are reversible by psychological interventions mitigating distress. We report on pro-inflammatory, sympathetic, and oxidative stress gene expression in response to stress management for caregivers of allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients. Following randomization by permuted block to either treatment as usual (TAU, n = 11) or a stress management intervention (PsychoEducation, Paced Respiration, and Relaxation, PEPRR, n = 13), twenty-four caregivers were selected at the conclusion of a larger trial of 149 caregivers. PEPRR was provided one-on-one beginning around transplant. Genome-wide transcriptional profiling was conducted on peripheral blood mononuclear cells collected prior to randomization and on completion of PEPRR 3 months post-transplant. Bioinformatics analysis of differentially expressed genes indicated reduced activity of transcription control pathways associated with inflammation (NF-κB), sympathetic nervous system (CREB), and oxidative stress (NRF2) in caregivers receiving PEPRR compared to TAU aligning with reductions in stress, depression, and anxiety. This suggests that PEPRR may alter transcriptomic effects reported for distressed individuals.

Caregivers of patients receiving allogeneic hematopoietic stem cell transplants (allo-HSCT) serve a pivotal role in patient care but experience high stress, anxiety and depression as a result. We theorized that stress management adapted for allo-HSCT caregivers would reduce distress compared with treatment as usual (TAU). Of 267 consecutive caregivers of allo-HSCT patients approached, 148 (mean=53.5 years, 75.7% female) were randomized to either psychosocial intervention (i=74) or TAU (n=74). Eight one-on-one stress management sessions delivered across the 100-day post-transplant period focused on understanding stress, changing role(s) as caregiver, cognitive behavioral stress management, pacing respiration and identifying social support. Primary outcomes included perceived stress (psychological) and salivary cortisol awakening response (CAR) (physiological). Randomized groups were not statistically different at baseline. Mixed models analysis of covariance (intent-to-treat) showed that intervention was associated with significantly lower caregiver stress 3 months post transplant (mean=20.0, 95% confidence interval (95% CI)=17.9-22.0) compared with TAU (mean=23.0, 95% CI=21.0-25.0) with an effect size (ES) of 0.39 (P=0.039). Secondary psychological outcomes, including depression and anxiety, were significantly reduced with ESs of 0.46 and 0.66, respectively. Caregiver CAR did not differ from non-caregiving controls at baseline and was unchanged by intervention. Despite significant caregiving burden, this psychosocial intervention significantly mitigated distress in allo-HSCT caregivers.

The accurate indication of saliva collection time is important for defining the diurnal decline in salivary cortisol as well as characterizing the cortisol awakening response.. We tested a convenient and novel collection device for collecting saliva on strips of filter paper in a specially constructed booklet for determination of both cortisol and DHEA. In the present study, 31 healthy adults (mean age 43.5 yrs.) collected saliva samples four times a day on three consecutive days using filter paper collection devices (Saliva Procurement and Integrated Testing (SPIT) booklet) which were maintained during the collection period in a large plastic bottle with an electronic monitoring cap. Subjects were asked to collect saliva samples at awakening, 30 min. after awakening, before lunch and 600 min. after awakening. The time of awakening and the time of collection before lunch were allowed to vary by each subjects’ schedule. A reliable relationship was observed between the time recorded by the subject directly on the booklet and the time recorded by electronic collection device (n = 286 observations; r2 = 0.98). However, subjects did not consistently collect the saliva samples at the two specific times requested, 30 and 600 min. after awakening. Both cortisol and DHEA revealed diurnal declines.. In spite of variance in collection times at 30 min. and 600 min. after awakening, the slope of the diurnal decline in both salivary cortisol and DHEA were similar when we compared collection tolerances of ± 7.5 and ± 15 min. for each steroid.. These unique collection booklets proved to be a reliable method for recording collection times by subjects as well as for estimating diurnal salivary cortisol and DHEA patterns.

Allogeneic stem cell transplantation is a common form of treatment for many types of blood cancers and requires active caregiver involvement for 100 days or longer [1]. The stress of caregiving starts before transplantation when families are preparing for the adversities of the transplant process. Caregivers are often involved in patients’ treatment prior to transplantation since most caregivers are patients’ immediate family members. As the start of transplant nears, the realities of the decision to proceed to transplant and associated risks for morbidity and mortality become increasingly concrete to the patient and caregiver. Although there is potential for significant improvement in the patients’ disease status following transplant, there remains a high level of risk with the transplant procedure. Understanding caregiver adjustment to these peri-transplant stressors is important to identify support needs and develop interventions to help caregivers meet the caregiving challenge. Caregivers of cancer patients face considerable risk regarding their own well-being. The burden of caregiving can have a significant impact on emotional, physical and social functioning [2-7], as well as immune and neuroendocrine processes [8, 9]. The patient and caregiver are closely connected in their experiences of dealing with the cancer; patient physical and psychological well-being is related to caregiver emotional and psychological well-being [10, 11]. From a systems perspective, this relationship would be bidirectional. Thus, caring for the caregiver is important for the health of the caregiver as well as the health of the patient. Despite the critical role of caregivers, only limited research has focused on the caregiver experience and even fewer studies have focused on the caregiver during the allogeneic peri-transplant period. When allogeneic transplant patients and caregivers (n=40 and n=39, respectively) were compared on their pre-transplant psychosocial and psychological functioning, patients and caregivers reported significant distress prior to transplant [12]. Relatives of autologous and allogeneic transplant recipients reported stress significantly above the norm on the General Health Questionnaire, with stress greatest before and immediately following transplant [10]. Caregivers experienced greater anxiety and depression prior to transplant than five and 20 days post-transplant [13]. In a large study of autologous transplant caregivers (n=102), caregivers reported low levels of fatigue yet moderate levels of anxiety prior to transplant compared to population norms [14]. These studies suggest distress experienced by transplant caregivers is especially acute in the period preceding and immediately following transplantation of stem cells, i.e., the peri-transplant period. However, studies are limited by small sample sizes, restrictions in outcomes assessed, and heterogeneous patient groups consisting of both autologous and allogeneic transplant recipients or only autologous patient groups who present different caregiver challenges than allogeneic caregivers. The purpose of this study was to describe the peri-transplant psychological status in a sample of caregivers of allogeneic transplant patients using measures of mood, perceived stress, sleep, and caregiving burden while determining if demographic or patient illness characteristics prior to transplant predicted levels of caregiver distress. We predicted that caregiver sex, age and patient status would contribute to overall peri-transplant caregiver distress. We hypothesized that female caregivers and younger caregivers would experience more distress than male or older caregivers.

BACKGROUND Caregiving for allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients can be significantly burdensome. Caregiver well-being often mirrors patients' suffering. However, to our knowledge, this dyadic relationship has not been linked to patient outcome. OBJECTIVE Caregiver's objective and subjective sleep and overall distress before transplantation were hypothesized to be related to patient's time to engraftment in secondary analyses. METHODS Dyads (N = 124) were Allo-HSCT patients (mean [SD] age, 49.2 [12.7] years) and their caregivers (mean [SD] age, 52.7 [12.3] years). Caregiver's subjective sleep quality was measured via the Pittsburgh Sleep Quality Index, objective sleep was measured by actigraphy, and distress was measured by combining validated psychological measures. RESULTS Both caregiver reports of worse sleep (β = .22; P < .05) and objective measurement of caregiver sleep patterns (higher sleep efficiency; less time awake after sleep onset) collected before engraftment significantly predicted shorter time to patient engraftment (β values = -.34 and .29, respectively; P values < .05). Caregiver distress was unrelated to engraftment (β = .14; P = .22). CONCLUSIONS Despite limitations in available patient data, these findings appear to link caregiver well-being to patient outcome. This underscores the interrelatedness of the patient-caregiver dyad in Allo-HSCT. Future research should examine psychological and biomedical mediators. IMPLICATIONS FOR PRACTICE Given that caregiver well-being during the peritransplantation period was associated with patient outcome in this study, such findings highlight the need to address caregiver and patient well-being during Allo-HSCT. There may be potential to improve patient outcome by focusing on the caregiver, which nursing staff is well positioned to monitor.

Background The literature regarding milk composition in non-human primates collected across offspring development is limited. We assayed milk samples from bonnet macaque (Macaca radiata) mothers as part of studies characterizing development of this species. Methods Milk was obtained when possible longitudinally from seven lactating bonnet macaque mothers. Samples were frozen until analysis. Individual samples were analyzed to determine the concentrations of electrolytes including sodium, potassium, calcium, chloride, and magnesium, as well as urea, protein, lipids, glucose, and lactose. Results A trend for increased lipids as well as protein percentage was noted with increasing infant age. Chloride and calcium showed an increase with age, whereas other electrolytes remained relatively stable across development. Conclusions The composition of the milk of this particular macaque species was similar to other Old World primates as well as humans. These data add to the limited information available on milk constituents among mammals.

OBJECTIVE Caregiving for allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients carries a significant psychological burden, yet it remains unclear whether Allo-HSCT caregivers demonstrate disruptions to stress systems, such as the hypothalamic-pituitary-adrenal axis. Greater intraindividual cortisol variability (ICV) has been observed in psychiatric disorders; however, there is a knowledge gap evaluating ICV in caregivers. We predicted that greater ICV would be related to poorer mental health in Allo-HSCT caregivers. METHODS Allo-HSCT caregivers (n = 140) collected saliva for 3 consecutive days at 4 time points/d. Psychological variables included sleep quality and a summary composite score of overall mental health. RESULTS Regression analyses demonstrated that greater ICV was significantly related to poorer overall mental health (β = 0.25, p = .009), whereas poorer sleep did not reach significance (β = 0.16, p = .069). No significant relationships emerged for the cortisol area under the curve, diurnal decline, or awakening response. CONCLUSIONS Results extend prior work examining ICV as a unique marker that is possibly more sensitive than other widely applied measures of hypothalamic-pituitary-adrenal axis dysregulation to a distressed population of caregivers.

A full-time 24/7 caregiver is required for 100 days or longer following an allogeneic blood or marrow transplant during which time caregivers have multiple demands. Although distress in caregivers is documented, generalization is limited by small sample sizes, restricted range of assessments, and lack of information as to which caregivers may be more vulnerable to distress. The purpose of this study was to describe the peri-transplant psychological status of a sample of caregivers of allogeneic transplant patients.We assessed caregiver mood, stress, burden, and sleep using valid self-report measures in 109 caregivers of allogeneic transplant patients prior to stem cell transplantation. Caregivers' scores were compared with norms or established cutoff scores for behavioral measures. Additionally, demographic characteristics such as age and sex were tested as predictors of distress.Caregivers showed significant levels of anxiety, stress, intrusion and avoidance behaviors, and poor sleep at the start of transplant compared with established norms. Younger caregivers were more distressed than older caregivers. There were no differences in levels of distress between male and female caregivers.The peri-transplant period is a time of heightened anxiety and distress for caregivers of allogeneic transplant patients. This study indicates that caregivers would benefit from support programs in the peri-transplant period. Recommendations for types of support that may be helpful to caregivers are provided, but additional research is needed to validate that these programs would help caregivers providing care to patients receiving an allogeneic transplant in the peri-transplant period.

Maternal stress during pregnancy is associated with negative maternal/child outcomes. One potential biomarker of the maternal stress response is cortisol, a product of activity of the hypothalamic–pituitary–adrenal axis. This study evaluated cortisol levels in hair throughout pregnancy as a marker of total cortisol release. Cortisol levels in hair have been shown to be easily quantifiable and may be representative of total cortisol release more than single saliva or serum measures. Hair cortisol provides a simple way to monitor total cortisol release over an extended period of time. Hair cortisol levels were determined from each trimester (15, 26 and 36 weeks gestation) and 3 months postpartum. Hair cortisol levels were compared to diurnal salivary cortisol collected over 3 days (3 times/day) at 14, 18, 23, 29, and 34 weeks gestational age and 6 weeks postpartum from 21 pregnant women. Both salivary and hair cortisol levels rose during pregnancy as expected. Hair cortisol and diurnal salivary cortisol area under the curve with respect to ground (AUCg) were also correlated throughout pregnancy. Levels of cortisol in hair are a valid and useful tool to measure long-term cortisol activity. Hair cortisol avoids methodological problems associated with collection other cortisol measures such as plasma, urine, or saliva and is a reliable metric of HPA activity throughout pregnancy reflecting total cortisol release over an extended period.

Caregiving for hematopoietic stem cell transplant patients (HSCTp) is burdensome resulting in inadequate self-care, possibly leading to negative patient outcome. This potential Caregiver–HSCTp relationship was examined through assessment of caregiver objective and subjective sleep measures. We hypothesized that better caregiver sleep would be related to shorter time to patient engraftment (TtoE). Dyads ( N = 109) were HSCTp (M (SD) age = 48.2(12.7)) and caregivers (M (SD) age = 52.7(12.6)). Linear regression controlled for clinically relevant patient variables (age, sex, pre-transplant treatment intensity, clinical status). Better caregiver subjective sleep quality (Pittsburgh Sleep Quality Index) and objective sleep efficiency (SE; actigraphy) collected prior to engraftment significantly predicted TtoE (std beta’s = .20 and −.30 respectively; p ’s p R squared = 24%). Further, the timespan of sleep assessment relative to engraftment (M (SD) days = 18.5(12.1)) was controlled for to address the potential bidirectional relationship (e.g., shorter TtoE led to better caregiver sleep), and significant effects of caregiver SE remained (std beta = −.18; p (Supported by NIH grant CA126971 and PCORI contract CE-1304-6208.)

Psychological stress is not completely understood with relation to physiologic stress, such as inflammation and the HPA axis. Dysregulation between the HPA axis and inflammation can be estimated using a ratio of cortisol/C-reactive protein (Cort/CRP). We recently demonstrated that Cort/CRP is related to psychological variables in distressed caregivers, but is this ratio related to treatment response to an 8-session individual cognitive behavioral stress management (CBSM) intervention? 106 caregivers (75% women) of patients undergoing allogeneic stem cell transplant (M age = 51.6; SD = 11.9 years) provided one blood sample prior to transplant as well as contemporaneous diurnal saliva samples for assessing cortisol across 3 days for calculation of area under the curve (AUCg). CRP and Cortisol were assessed by EIA. Change scores were calculated from baseline to following CBSM for several psychological measures: depression (CESD), anxiety (StaiS), and perceived stress (PSS). Regression analyses revealed a significant interaction between Cort/CRP and treatment compared to treatment as usual in regards to CESD ( β = −.413; p = .05), and StaiS ( β = −.331; p = β = −.068; p =.682), such that a lower Cort/CRP ratio was related to a greater decrease in CESD and StaiS scores following CBSM. Diurnal salivary cortisol represented as AUCg may be useful in examining Cortisol/CRP. Caregivers with a lower cortisol/CRP may display greater psychological improvement with CBSM intervention. (Funding from NIH CA126971 (MLL); T32AG044296 (TS): DA034604 (SMG) and PCORI CE13046208 (MLL).

Homeostasis is reflected by interactions of the hypothalamic pituitary adrenal axis and inflammation. Indirect insights may be gained from ratios of plasma cortisol/C-reactive protein (Cort/CRP) as well as neutrophils/lymphocytes (N/L). However, can diurnal salivary cortisol be substituted in this relationship and do these ratios relate to psychological distress? 105 caregivers (75% women) of patients undergoing allogeneic stem cell transplant (Mage = 51.4; SD = 11.8 years) provided blood samples on a single occasion prior to transplant as well as saliva samples for cortisol at 4 time points across 3 days to compute the area under the curve with respect to ground (AUCg). CBCs were determined electronically, CRP was assessed by high sensitivity EIA, and salivary cortisol by EIA. Psychological measures included the CESD, STAI, and PSQI. State anxiety scores were significantly related to N/L ( r = .24, p r = .11); CORT_AUC/CRP was highly correlated with poor sleep ( r = −31; p r = −.17; p = .08). The relationship with sleep remained after adjusting for multiple comparisons and controlling for age and gender in regression ( β = −.32; p

Caregiving for hematopoietic stem cell transplant patients (HSCTp) carries a psychological burden and may affect HPA-axis dysregulation. Greater intraindividual cortisol variability (ICV) has been observed in a number of psychiatric conditions; however, no research has looked at ICV in caregivers. In this secondary analysis of cross sectional data we predicted greater ICV would be related to a lower psychological functioning in HSCTp caregivers. Participants (total n = 140) were primarily older (M age = 53.4, SD = 12.1) women ( n = 106). Salivary cortisol was collected using a filter paper method at 3 timepoints: at awakening, lunch and at 4PM. Psychological variables of interest included sleep quality (Pittsburgh Sleep Quality Index), mental health functioning (SF-36) and overall distress (principal component analysis). Multilevel modeling quantified ICV estimates. Correlation and regression analyses then examined relations between ICV and psychological variables of interest. ICV was significantly related to poorer sleep quality ( r = .17; p r = −.23; p r = .17; p p ’s (Supported in part by NIH grant CA126971 and PCORI contract CE-1304-6208.)

Caregiving represents a significant stressor affecting both behavioral and physiological regulation including increased inflammatory markers. At what time does caregiving begin to impact physiological and behavioral systems? As part of a randomized intervention for caregiver distress, we compared caregivers of blood or marrow transplant (BMT) recipients around the time of transplantation (baseline) to non-caregiving controls, with regard to plasma inflammatory markers (CRP and IL-6), blood pressure, BMI, natural cytotoxicity, and diurnal salivary cortisol. Female caregivers ( n = 51, age 50.6) were compared to female non-caregivers ( n = 19, age 47.9). Caregivers spent 10.7 h/day caring for the patient at baseline. Patients were diagnosed a median 18 months prior to transplant. Subjects completed the Perceived Stress Scale (PSS), Center for Epidemiological Studies-Depression scale (CESD), and Spielberger State Anxiety Inventory (STAI). Blood samples were assessed for inflammatory markers (CRP, IL6) by EIA. Lysis of K562 tumors indicating natural cytotoxicity was reported as lytic units/NK+ cell. At baseline, caregivers were significantly elevated on the PSS, CESD and STAI compared to controls ( NIH Grant CA126971 .)