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Caregivers of persons with dementia (PWDs) were socially isolated with little support during the COVID-19 pandemic “Stay-At-Home” order in the United States. To enhance social and emotional connection for diverse caregivers, a culturally/linguistically appropriate telephone intervention provided compassionate listening, mindful breathing, and COVID-19 safety education. The study purpose was to understand caregiving challenges and to evaluate the intervention for caregivers during the early pandemic using a qualitative approach. Twenty-three caregivers participated in the intervention provided by bilingual research assistants for 3 months. Call logs were used to describe the caregivers’ dialogue. Thematic analysis identified (a) the challenges, including fear of coronavirus disease, providing around-the-clock care, and forced isolation and negative emotions; and (b) caregivers’ experience with the intervention, including connecting with the outside, relief from emotional stress, reliable COVID-19 information, and reinformed caregiving skills. Results suggest that the telephone support was of benefit to diverse caregivers of PWDs during the pandemic by promoting social connection and reducing emotional distress.

Background: The coronavirus disease 2019 (COVID-19) pandemic has created a need for nurses who are perseverant and passionate, the definition of grit. This study examined grit levels in Master in Nursing (MSN) and Doctor of Nursing Practice (DNP) students. Method: MSN and DNP students were surveyed using the Grit-S scale, which is composed of two parts: Grit-CI (consistency of interest) and Grit-PE (perseverance of effort). Results: Overall, graduate nursing students had high levels of grit as measured by the Grit-S ( M = 3.9, SD = 0.5). Perseverance was higher for both MSN and DNP students than passion ( M = 4.2, SD = 0.5 vs. M = 3.6, SD = 0.7). There was no difference in Grit-S levels related to program type. Conclusion: Graduate nursing students had high levels of grit. With the challenges faced by nursing professionals during the COVID-19 pandemic, nurses with high grit levels may avoid burnout and persevere though challenges. [ J Nurs Educ . 2022;61(4):197–200.]

Youth impacted by homelessness experience diminished cognition due to a variety of reasons including mental health symptoms, alcohol and substance use, and adverse childhood experiences. However, the status of specific brain regions which could impact important cognitive functions in homeless youth remains unclear. In this pilot comparative and correlational study, a series of demographic, psychological, cognitive assessments, and brain magnetic resonance imaging were performed in 10 male youth experiencing homelessness and 9 age-matched healthy male controls (age range: 18–25 years). Participants experiencing homelessness had significantly decreased regional brain gray matter tissue in comparison to the controls. Moreover, there were strong inverse correlations between the brain regions classically associated with executive decision-making (prefrontal cortices), depression (insular lobes), and conflict resolution (anterior cingulate), and the level of the symptoms detected by their questionnaires.

Introduction Growing evidence shows the important role of sleep on cardiovascular health in pregnant women with nearly 50% self-reporting poor sleep quality and 30% insufficient sleep. These sleep disturbances have been associated with adverse perinatal outcomes (e.g., hypertension, preterm births). Many studies have only used self-reported questionnaires during pregnancy. However, a few studies have utilized sleep labs and found that subjective and objective assessments of sleep varied from poor to low associations. The aim of this study was to examine the longitudinal relationship between objective sleep and cardiovascular parameters in pregnant women. Methods Seventeen healthy pregnant women with 88% self-identifying as Hispanic were consented to participate in the longitudinal observation study. Their average age was 27.8 years (SD=4.48). A validated Oura ring was used to daily monitor objective sleep and cardiovascular parameters across the pregnancy, including resting heart rate (HR), heart rate variability (HRV) indicated by RMSSD (root mean square of successive differences) of interbeat intervals, deep, light, and Rapid EYE Movement (REM) sleep, awake time and sleep onset latency. Mixed effects models were conducted to analyze daily changing patterns of these parameters using R-4.2.0 for Mac. Results Over the pregnancy, when deep and light sleep increased by 1 hour, heart rate decreased by 5.55 bpm (p< 0.001) and 1.32 bpm (p = 0.01), respectively; when REM sleep increased by 1 hour, heart rate increased by 2.15 bpm (p =0.049). Conversely, when deep and light sleep increased by 1 hour, RMSSD increased by 10.32 ms (p< 0.001) and 2.93 ms (p< 0.02), respectively; when REM sleep increased by 1 hour, RMSSD decreased by 7.27 ms (p=0.001). There were no significant associations between HR/RMSSD and awake time/sleep onset latency. Conclusion This study appears to be the first to investigate the longitudinal relationship between sleep and cardiovascular parameters among primarily Hispanic pregnant women in the U.S. in a non-lab setting. Our study provides preliminary evidence that longer deep/light sleep and shorter REM sleep may improve cardiovascular health among pregnant women. Support (if any) National Science Foundation grants including the Smart and Connected Communities (CNS: 1831918) and Collaborative Research: Integrative Heterogeneous Learning for Intensive Complex Longitudinal Data (DMS: 2210640).

Purpose We aimed to understand the relationship between exercise and stress among socioeconomically at-risk women who participated in a home visitation service during pregnancy and postpartum. Methods A mixed-methods design was used to support and supplement quantitative data using qualitative data. Convenience sampling was used to collect data from at-risk women via questionnaires and follow-up interviews. The Perceived Stress Scale was used to assess stress. Frequency and duration of exercise were assessed based on the American College of Obstetricians and Gynecologists exercise guidelines. Regression analyses examined the association between stress and exercise controlling for covariates. Content analysis was used to understand women's stress management experiences. Results N = 114 women completed the questionnaire and a subgroup of 11 received follow-up interviews. Greater frequency of exercise was significantly associated with lower levels of stress. Approximately one-third of women reported experiencing significant stress. Talking to their husband or partner was the most used and exercise was the least used coping strategy. Many women recognized the importance of managing stress and benefits of exercise, but were hindered by barriers such as feeling tired, preventing them from exercising. Clinical implications A personalized and safe exercise program has the potential to be a low-cost stress management strategy for women during pregnancy and postpartum.

BACKGROUND The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. OBJECTIVE The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user’s engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. METHODS A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app–based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. RESULTS Decreased resting heart rate was significantly correlated with increased heart rate variability (r=–0.92, POura ring measures: (1) positive emotions and heart rate variability (r=0.54, Pr=0.52, P<.001), and (3) physical activity and step count (r=0.77, P CONCLUSIONS The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.

PURPOSE The study aimed to examine how registered nurses (RNs) and paraprofessional home visitors (PHVs) work together as a team to care for underserved perinatal women in a coordinated home visitation program. DESIGN AND METHODS Qualitative methods were used to understand the perspectives of three RNs and twenty PHVs who worked at MOMS Orange County, a community-based perinatal health program. Individual one-on-one interviews were administered with the RNs and focus groups with the PHVs. Qualitative content analysis was conducted to synthesize themes. RESULTS RNs perceived themselves as educators, mentors, and supervisors. PHVs thought of themselves as supporters, coaches, and advocates. Interdependence and proactive communication were favorable characteristics of the relationship in which RNs trained PHVs to provide health education. The positive interactions between RNs and PHVs appeared to enhance the client-healthcare provider connection. CONCLUSIONS Our study is one of the first to describe relationships and communication patterns among the healthcare team in a coordinated home visitation program in the United States. Future studies should examine how additional members of the team, including clients and healthcare providers, view their experiences with a home visitation program.

Dementia is a major public health problem affecting 5.5 million people in the United States This qualitative study explored the caregiving experience of Korean American (KA) families of persons with dementia (PWD). Adult KA caregivers of PWD (n = 18) were recruited for semi-structured interviews. Thematic analysis yielded four themes: challenges in finding resources, struggling with mental health issues, traveling the path of acceptance, and finding ways to survive. Due to the language barrier, most KA caregivers reported using Korean Internet for information on dementia and caregiving. Some traveled to South Korea seeking medical assistance for dementia (medical tourism). Importantly, some KA caregivers expressed suicidal thoughts and depression. Unexpectedly, familism prevented help seeking and possible relief from their difficulties. There is an urgent need to improve access to dementia care services and education for the KA community. Building a trusting relationship with healthcare providers is even more important for KA caregivers to address their mental health concerns.

Introduction: Little is known of late adolescent Texas Latinas’ prenatal care perceptions or how these perceptions predict timely prenatal care initiation or adequate utilization. Hence, the purpose of this study is to describe and compare these perceptions between participants with timely versus late prenatal care initiation and adequate, intermediate, and inadequate prenatal care utilization; and to determine predictors of timely prenatal care initiation and adequate utilization. Methods: Fifty-four postpartum Latinas were recruited through social media. Eligibility criteria were 18 to 21 years old, Texas-born, primiparous, uncomplicated pregnancy/delivery, and English literate. Prenatal care perceptions were measured with the Revised Better Babies Survey and Access Barriers to Care Index. Results: Participants had favorable views of prenatal care benefits; however, not living with the baby’s father predicted inadequate prenatal care, Wald χ2(1) = 4.93, p = .026. Perceived benefits of timely and adequate prenatal care predicted timely prenatal care initiation, χ2(1) = 7.47, p = .006. Self-reported depression during pregnancy predicted timely entry into prenatal care, χ2(1) = 4.73, p = .03. Conclusion: Participants’ positive prenatal care perceptions did not predict adequate prenatal care utilization, indicating that barriers serve as powerful obstacles in late adolescent Texas Latinas.

An Emotional Health Curriculum (EHC) was developed to promote positive mental health in primarily Hispanic elementary school-aged children. In order to further expand the EHC, the mothers' experiences with the curriculum were examined. Eighteen mothers participated in two focus groups. Mothers reported that they valued this curriculum as a preventive program. Importantly, all mothers wished to extend their involvement to not only assisting their child in completing the curriculum homework but also attending a proposed parenting program. This study provides preliminary evidence that mothers embraced the EHC as an accessible community mental health service for their children and sought greater involvement.

High rates of mental health problems in adolescents have been well documented; less is known about elementary school children in disadvantaged communities. We examined emotional and behavioral health needs in 202 third and fourth graders enrolled in a charter school in a largely Hispanic community. The child-reported Revised Child Anxiety and Depression Scale-25 and Teacher’s Report Form were used to evaluate mental health needs as perceived by these children and their teachers. The prevalence of teacher-reported depression and child self-reported anxiety was 7.0% and 6.67%, respectively. Living in a single parent household was found to be a specific risk factor in that those children had higher rates of emotional and behavioral problems than children living with both parents. Evidence of higher depression and anxiety identified in this sample compared to national representative data suggests the need for development of culturally sensitive early prevention and intervention in this underserved community.

Author(s): Guo, Yuqing; Rousseau, Julie; Renno, Patricia; Kehoe, Priscilla; Daviss, Monique; Flores, Sara; Saunders, Kathleen; Phillips, Susanne; Chin, Mindy; Evangelista, Lorraine S | Abstract: PROBLEM:Hispanic children have greater mental health challenges but fewer received mental health services than other ethnic groups. A classroom-based Emotional Health Curriculum (EHC) was developed to address mental health disparities in an underserved Hispanic community. METHODS:A quasi-experimental design with one group pre- and post-intervention was used to test the feasibility of an 8-week EHC for one hundred 3rd and 4th grade children in a dual-immersion Spanish-English elementary school. Limited efficacy was measured by changes in depression and anxiety scores reported by children and teachers. Acceptance was evaluated by a child-reported satisfaction survey and a focus group in which the four teachers shared their experiences. Implementation was measured by participation, retention, and fidelity rates. FINDINGS:The child-reported depression and anxiety and teacher-reported depression were significantly decreased in at-risk children with the effect size ranging from 0.60 to 1.16 (psnln0.05). The majority of children (89.7%) enjoyed the EHC and teachers observed that children had acquired skills to manage their emotional distress. The participation, retention, and fidelity rates were 98%, 94%, and 99.13%, respectively. CONCLUSIONS:The results provide promising evidence that the EHC has the potential to improve depression and anxiety symptoms in at-risk children.

Background Latinos report higher rates of depression and anxiety than US whites but are less likely to receive care. Transmedia storytelling interventions accessible on the Internet via smartphones, tablets, and computers hold promise for reducing reluctance to explore or get help for symptoms because they are private, convenient, and can reach large numbers of people, including Latinas with mental health needs. Objective The purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a mental health transmedia intervention for Latinas with elevated symptoms of depression, anxiety, or both. Methods A total of 28 symptomatic English-speaking Latina women aged 21 to 48 years participated in a 6-week study using a within-group design. All aspects of the study were completed via telephone or Internet. Participants used their personal devices to engage the Web-based transmedia intervention (in English) that included story-based videos, a data-informed psychotherapeutic video, an interactive video sequence, and a blog written from the point of view of one of the characters with links to mental health resources. Perceived confidence to get help and perceived importance for seeking immediate help were both measured using single-item questions. Participants completed surveys at baseline (via telephone) and 1 and 6 weeks after media engagement that measured various factors, including depression (Patient Health Questionnaire; PHQ-9 and PHQ-8) and anxiety (Generalized Anxiety Disorder scale; GAD-7). A telephone interview was conducted within 72 hours of media engagement. Action taken or intentions to get help (single-item question) and talking about the videos with others (single-item question) were measured 1 and 6 weeks after media engagement. Repeated measures analysis of variance was used to assess change in depression (PHQ-8) and anxiety (GAD-7) before transmedia engagement and 1 and 6 weeks after. Spearman correlations evaluated the association of confidence and importance of getting help with action taken, anxiety, and depression. Results All 28 Latinas (English speakers) who engaged with the transmedia remained in the 6-week study. Within 1 week of transmedia engagement, 39% of women took action to get help, and 82% discussed the media with others. Symptoms of depression (F2,54=9.0, P Conclusions Preliminary findings indicate a culturally tailored mental health transmedia intervention is a feasible approach that holds promise for engaging large numbers of symptomatic English-speaking Latina women to begin the process of seeking help, as well as decreasing symptoms of anxiety and depression.

Dementia takes a significant toll on caregivers resulting in their suffering from chronic stress and depression due to responsibility for care for persons with dementia (PWD). Behaviors of PWD could be aggravated by inappropriate responses by family caregivers such as correcting PWD’s memories. The study purpose is to examine the feasibility of a home-visit-based intervention designed to promote communication skills with PWD and well-being in family caregivers. This pilot study used a single-arm experimental pre-post design to test the feasibility of 4 weekly home visits for 13 female family caregivers in Southern California (spouse, n=7; adult children, n=6; mean age=64.3, ranging 46-82). Trained home visitors used video scenarios for behavioral education for caregivers. All caregivers completed the entire home visit program. Significantly caregiver burden was decreased from baseline (M(SD)=51.38(4.58)) to follow-up at 5 weeks (M=43.31(5.67), Wilcoxon signed rank test: p=.04). Additionally, caregiver-reported PWD’s negative behaviors were reduced from baseline to follow-up (Mbase=22.31(3.52), Mfolllowup=19.31(4.4), p=.13). There were other improvements (non-significant) in greater caregiver self-efficacy and less depressive symptoms from baseline to follow-up. Caregiver satisfaction with the intervention was high (M=4.6(0.65) of 5). Qualitatively, participants appreciated the home visits for educational sessions and welcomed the empathy provided. Caregivers expressed better communications and responsiveness to the PWDs. The results showed the home-visit-based caregiver intervention was feasible and had a potential effectiveness on reduction of caregiver burden and possibly on self-efficacy and well-being. A larger-scale study will be needed to demonstrate long term positive effects on caregiver interactive skills and their well-being.

Purpose The aim of this study is to compare the effects of chest physiotherapy (CPT) and high-frequency chest wall oscillation (HFCWO) on lung function in lung transplant recipients. Background Chest physiotherapy and HFCWO are routinely used after lung transplant to attenuate dyspnea, increase expiratory flow, and improve secretion clearance. Methods In a two-group experimental, crossover design with repeated-measures, 45 lung transplant recipients (27 single, 18 bilateral; 64% male; mean age, 57years) were randomized to receive CPT at 10:00 AM and 2:00 PM followed by HFCWO at 6:00 PM and 10:00 PM ( n =22) or vice versa ( n =23) on postoperative day 3. Dyspnea (modified Borg score), Spo 2 /FiO 2 , and peak expiratory flow (PEF) were measured pre-treatment and post-treatment. Data were analyzed using chi-square tests, t tests, and linear mixed effects models. Results There was no statistically significant treatment effect for dyspnea or PEF in patients who received HFCWO versus CPT. However, there was a significant treatment effect on the Spo 2 /FiO 2 ratio ( p Conclusions Preliminary results suggest that lung function (measured by Spo 2 /FiO 2 ) improves with HFWCO after lung transplantation. Although dyspnea and PEF did not differ significantly between treatment types, HFCWO may be an effective, feasible alternative to CPT.

Irritable bowel syndrome (IBS) supports the concept of a dysregulated hypothalamic—pituitary—adrenal (HPA) axis. This study investigates the neuroendocrine and psychological responses to the acute physical stress of a lumbar puncture (LP) in women with diarrhea-predominant IBS by assessing central and peripheral HPA activity and affective measures. Blood samples have been collected at baseline and immediately post- and 1 hr following LP from 13 women with IBS and 13 controls. Plasma adrenocorticotropic hormone (ACTH), cortisol, epinephrine, and norepinephrine levels are analyzed. A single measure of cerebrospinal fluid (CSF) concentrations of corticotropin-releasing factor (CRFCSF) and norepinephrine CSF is noted. Affective assessments are used to rate anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) and acute mood state is rated using the Stress Symptom Rating questionnaire (stress, anxiety, anger, arousal). The women with IBS display blunted ACTH and cortisol responses to the LP along with a profile of affective responsiveness suggestive of chronic psychosocial stress, although no CRF CSF differences between groups are observed.

Early life events have profound consequences. Our research demonstrates that the early life stress of neonatal isolation (1-h individual isolation on postnatal days 2–9) in rats has immediate and enduring neural and behavioral effects. Recently, we showed neonatal isolation impaired hippocampal-dependent context conditioned fear in adult rats. We now expand upon this finding to test whether neonatal isolation impairs performance in inhibitory avoidance and in the non-aversive, hippocampal-dependent object recognition task. In addition to assessments of hippocampal-dependent memory, we examined if neonatal isolation results in cellular alterations in the adult hippocampus. This was measured with antibodies that selectively label calpain-mediated spectrin breakdown product (BDP), a marker of cytoskeletal modification that can have neuronal consequences. Neonatally isolated male and female rats showed impaired performance in both memory tasks as well as elevated BDP levels in hippocampal immunoblot samples. In tissue sections stained for BDP, the cytoskeletal fragmentation was localized to pyramidal neurons and their proximal dendrites. Interestingly, the hippocampal samples also exhibited reduced staining for the postsynaptic marker, GluR1. Neonatal isolation may render those neurons involved in memory encoding to be vulnerable to calpain deregulation and synaptic compromise as shown previously with brain injury. Together with our prior research showing enhanced striatal-dependent learning and neurochemical responsivity, these results indicate that the early experience of neonatal isolation causes enduring yet opposing region-specific neural and behavioral alterations.

Previously, we demonstrated that the early life stress of neonatal isolation facilitates acquisition of cocaine and food self-administration in adult female rats. We now test whether it enhances responding for these reinforcers after operant performance is established. Adult female rats were derived from litters that were either subjected to neonatal isolation (1 h/day isolation; postnatal days 2-9) or were nonhandled and assigned to one of two experiments. In Experiment 1, female rats well trained to self-administer cocaine were tested under a fixed-ratio 3 (FR3) schedule with several cocaine doses (0.0625-1.0 mg/kg/infusion) and under a progressive-ratio (PR) schedule (0, 0.5, and 1.0 mg/kg/infusion cocaine). In Experiment 2, female rats well trained to respond for food reinforcers under an FR15 schedule were tested under two PR schedules. Results show that neonatal isolation enhanced responding for cocaine under both schedules of reinforcement and increased responding for food under a PR schedule of reinforcement. These data extend our previous acquisition study in female rats to show that neonatal isolation enhances responding under maintenance conditions. These enduring behavioral changes may relate to the ability of neonatal isolation to increase striatal dopamine responses to psychostimulants, effects we showed previously in infant and juvenile rats. Neuropsychopharmacology (2006) 31, 70-76. doi:10.1038/sj.npp.1300779; published online 1 June 2005.

Our research demonstrates that neonatal isolation (ISO; 1 h/day isolation; postnatal days 2-9) enhances extracellular, ventral striatal dopamine (DA) responses to psychostimulants in infant and juvenile rats. In adult rats, we find ISO facilitates acquisition and maintenance of cocaine self-administration. We now test whether ISO enhances cocaine-induced accumbens DA levels in adults using in vivo microdialysis. Behavioral responses to cocaine and DA antagonists were also examined. Adult male rats were derived from litters subjected to ISO or nonhandled (NH) control conditions. In experiment 1, microdialysis probes were aimed at accumbens core and separate groups administered vehicle or cocaine (5 and 10 mg/kg i.p.). Samples were analyzed for DA levels via high-performance liquid chromatography. In experiment 2, ISO and NH rats were administered one of these cocaine doses, and locomotor activity was assessed. Effects of cocaine (0.3-30 mg/kg), the D(1) antagonist SCH23390 [R-(+)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine (0.003-0.03 mg/kg)], and the D(2) antagonist eticlopride (0.01-0.1 mg/kg) on disruption of responding for food were examined in experiment 3. Cocaine plasma levels were assessed in experiment 4. ISO enhanced cocaine-induced increases in accumbens DA levels. Furthermore, the D(2), but not D(1), antagonist disrupted behavior to a greater extent in ISO versus NH rats. Yet, ISO did not significantly alter behavioral responses to cocaine or cocaine plasma levels. These data show that the ability of ISO to enhance accumbens DA responses to cocaine endures into adulthood. Moreover, that ISO rats are more sensitive to a D(2) antagonist may reflect decreased levels of this receptor type as we showed previously in infant rats.

Previously, we demonstrated that neonatal isolation increases acquisition of cocaine self-administration in adult male rats.Now we examine whether neonatal isolation enhances maintenance and cocaine-induced reinstatement of extinguished self-administration behavior. To test the specificity of the effect, a separate study examined maintenance of food responding.Litters were subjected to neonatal isolation (individual isolation; 1 h/day; postnatal days 2-9) or were non-handled. In experiment 1, adult male rats trained to self-administer cocaine (0.5 mg/kg per infusion; fixed-ratio 3 or FR3) were tested under fixed and progressive ratio (PR) schedules with different cocaine doses (0.125-1.0 mg/kg per infusion). After cocaine self-administration was extinguished, cocaine (0.5 or 2 mg/kg)-induced reinstatement of responding was assessed. In experiment 2, responding for food under an FR15 and two PR schedules were assessed in separate groups of neonatally isolated and non-handled male rats.Neonatally isolated rats responded for low cocaine doses at higher rates and infused more cocaine relative to non-handled rats under both FR and PR schedules. However, there are no group differences in cocaine-induced reinstatement or in responding for food under the PR schedules. However, neonatally isolated rats lever pressed for food at lower rates under the FR schedule.Together with our previous studies, the results of the present study suggest that the early life stress of neonatal isolation enhances cocaine-taking (acquisition and maintenance) at lower doses but does not alter drug-induced cocaine-seeking (reinstatement) behavior.

Cocaine-induced increases in ventral striatal dopamine levels are enhanced in adult rats previously exposed to chronic stress. In neonatal rats, isolation from dam, nest, and siblings is stressful as evidenced by elevated corticosterone levels, an effect that increases with chronic isolation. Whether chronic neonatal isolation cross-sensitizes to cocaine leading to greater increases in ventral striatal dopamine levels was assessed in this study. Litters were assigned to isolate or non-handled conditions. After culling on postnatal Day 1 (PN1), pups in the neonatal isolation condition were isolated individually for 1 h/day on PN days 2-9 while pups in the non-handled condition were left undisturbed. On PN10, pups were implanted with probes aimed at the ventral striatum. Baseline measures of dopamine and its metabolite, DOPAC, were obtained. Separate groups of male and female pups were then administered 0, 2.5, 5.0, or 10 mg/kg cocaine and samples were collected for 2-h. Isolate pups showed greater cocaine-induced increases in ventral striatal dopamine levels than non-handled pups. However, DOPAC levels did not differ by isolation condition or gender. Neonatal isolation-induced increases in the effects of cocaine on ventral striatal dopamine levels are consistent with our previous study using amphetamine in 10-day-old pups and show that chronic stress sensitizes the dopamine response to psychostimulants in infant rats.

Rat pups were individually isolated from the mother and nest for 1 h/day from postnatal days (PND) 2 to 9 and tested as juveniles (PND 26–30) compared to nonhandled (NH) controls. In response to 1 h of restraint stress, NH rats increased locomotor activity and dopamine (DA) levels, but neonatally isolated (ISO) rats did not. Both groups had increased plasma corticosterone levels in response to restraint, but corticosterone levels were higher in ISO than in NH. Brain allopregnanolone (3α,5α-THP) levels also increased in response to stress, but NH and ISO did not differ. Sex of the rats was not a factor for any of the measures except plasma corticosterone levels, where females had higher levels than males. These data indicate that the effects of neonatal isolation persist postweaning and that the effects are most evident in response to stress as opposed to under baseline conditions.

Early life events have been thought to contribute towards vulnerability to drug addiction later in life. In the present investigation, the effect of daily neonatal maternal isolation stress on NMDA channel activity was studied. [3H]MK-801 binding was measured in several brain regions from neonatally isolated (ISO) and nonhandled (NH) adult male and female rats. Maximal [3H]MK-801 binding in the caudate-putamen of male ISO rats was 58% higher compared to same sex NH rats. Unlike male rats, maximal [3H]MK-801 binding in the caudate-putamen of female ISO rats was lower than female NH rats. No other brain region showed any significant difference in maximal [3H]MK-801 binding between ISO and NH male and female rats, respectively. There was no effect of pup isolation on the binding affinity (K(d) value) in either sex. Repeated maternal isolation is associated with alterations in the NMDA channel activity in the caudate-putamen of adult rats, and may be responsible for the augmentation in the addictive behavior reported.

This experiment investigated whether neonatal isolation stress alters central concentrations of progestins. Whole brain progesterone (P), dihydroprogesterone (DHP), and allopregnanolone (3alpha, 5alpha-THP) were measured in pups that were isolated from the nest, dam, and siblings for 1 h on postnatal days (PND) 2-9 and were compared to control litters of pups that were not isolated. Isolated 2-day-old pups had significantly lower central P and higher P to DHP and 3alpha, 5alpha-THP metabolism ratios. On PND 9, pups that had been repeatedly isolated (PND 2-8), had significantly lower whole brain DHP and significantly greater whole brain 3alpha, 5alpha-THP compared to controls. Thus, the biosocial stress of isolation in neonatal rats alters central pregnane steroids.

Sonographic analysis of isolation-induced calls of 10- to 17-day-old Sprague-Dawley rat pups showed that average acoustic parameters of calls changed with pups' age. Average call duration increased with age from 80 ms to over 140 ms in 15-day-old pups. The peak frequency increased from approximately 50 kHz to an average of 64 kHz in 17-day-old pups, and the average bandwidth increased from 34 to 45 kHz in 17-day-old pups. Analysis of the sonographic structure of pup calls additionally revealed a tendency to produce two or more alternating sweeps of sound frequency in each call. Development of sweeps is the most typical feature of pup calls with a dominant call type resembling "U" or inverted "U" shape in the sonogram. Number of "U" or inverted "U" call types significantly increased with pups' age. It is concluded that pups developed and strengthened those acoustic features of distress calls which play a role in intraspecific communication and maximize pup survival.

We previously reported that neonatal isolation stress significantly changes measures of hippocampal long-term potentiation (LTP) in male and female juvenile rats, i.e., at 30 days of age. The changes in dentate granule population measures, i.e., excitatory postsynaptic potential (EPSP) and population spike amplitude (PSA), evoked by tetanization of the medial perforant pathway, indicated that juvenile rats exposed to neonatal isolation exhibit different enhancement profiles with respect to both the magnitude and duration of LTP in a sex-specific manner. Isolated males showed a significantly greater enhancement of LTP, while female “isolates” showed significantly longer LTP duration when compared to all other groups. The present study was designed to determine whether the effects of the neonatal isolation stress paradigm endures into adulthood. Rats isolated from their mothers for 1 h per day during postnatal days 2–9 were surgically prepared at 70–90 days of age, with stimulating and recording electrodes placed in the medial perforant pathway and the hippocampal dentate gyrus, respectively. Prior to tetanization, no significant effect of sex or treatment was obtained for baseline measures of EPSP slope or PSA. In order to rule out baseline differences in hippocampal cell excitability in female adult rats, we measured the response of dentate granule cells for one estrus cycle and found no pretetanization enhancement in the evoked response in either controls or previously stressed rats. Following tetanization, there was a significant treatment and sex effect. During the induction of LTP, PSA values were significantly enhanced in both isolated males and females and had significantly longer LTP duration when compared to the unhandled control group. Additionally, we observed that females took longer to reach baseline levels than males. Taken together, these results indicate that repeated infant isolation stress enhances LTP induction and duration in both males and females. These results indicate that infant stress alters hippocampal neuroplasticity in such a way that its effect endures into adulthood. Hippocampus 1999;9:651–658. © 1999 Wiley-Liss, Inc.

This paper describes surgical and recording procedures that have been developed which permit the simultaneous monitoring of levels of select neurochemicals (via microdialysis) and measures of dentate-evoked field potentials within the hippocampal formation of freely moving adult rats. To test and evaluate these procedures, they were employed to examine changes in hippocampal neurochemistry and neuronal excitability associated with the establishment and maintenance of hippocampal long-term potentiation (LTP). Measures of hippocampal norepinephrine (NE) and glutamate levels along with measures of the dentate granule cell population spike amplitude (PSA) were obtained before, during, and after tetanization of the medial perforant path using two separate tetanization paradigms. Results obtained using these new procedures in several animals indicated that changes in NE and glutamate levels were strongly correlated with increases in the dentate granule cell PSA measure obtained following tetanization. The results indicate that this newly developed procedure can be effectively used to directly examine the relationship between neurochemical and neurophysiological changes associated with hippocampal neuroplasticity.

Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n=22) or vice versa (group 2, n=23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ2 and t tests and repeated-measures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P =.04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] vs 2 [15%], P=.01). However, single lung recipients showed no significant difference in preference between the 2 treatments (11 [42%] vs 14 [54%]). Conclusions HFCWO seems to provide greater decreases in pain scores than does chest physiotherapy. Bilateral lung transplant recipients preferred HFCWO to chest physiotherapy. HFCWO may be an effective, feasible alternative to chest physiotherapy. (American Journal of Critical Care. 2013;22:115–125)

A single 5-min isolation from the nest, dam, and siblings in 10-day-old rat pups was investigated for its effect on brain dopamine systems. The release of dopamine in innervated brain regions was measured in separate studies using in vivo ligand binding of 3 H-raclopride, ex vivo binding using 3 H-raclopride, and neurochemical measurement of the dopamine turnover using levels of DOPAC and dopamine. In addition, in vitro homogenate binding was performed to determine baseline B max and K d values for 3 H-raclopride binding sites across treatments. Isolation for 5 min in a “novel” environment resulted in decreased 3 H-raclopride binding in striatum and septum as determined by both in vivo and ex vivo binding, as well as increased dopamine turnover. There was no difference in B max and K d values for 3 H-raclopride in these brain regions after the 5-min isolation, indicating that the binding decreases were due to an increase of available dopamine, presumably from terminal release. The convergence of results from three different techniques supports the interpretation that dopamine is released during the 5-min isolation in both brain regions.

US-born Latinos report significantly more depression than foreign-born Latinos in the US, and Latinas have twice the rate of depression than Latino men. The purpose of this pilot study was to test the feasibility of an innovative, short term program of Schema Therapy (ST) combined with Motivational Interviewing (MI) techniques to reduce depression and increase resilience among second generation Latinas of low income in the US. In addition to blending ST and MI strategies with a focus on resilience, a novel technique called collaborative-mapping was a crucial strategy within treatment. Scheduling for sessions was flexible and patients had unlimited cell phone access to the therapist outside of sessions, although few used it. A mixed linear regression model for BDI-II scores of 8 women who completed all eight 2-hour sessions demonstrated that the treatment significantly decreased BDI-II scores during the course of treatment (p =.0003); the average decreasing rate in BDI-II scores was 2.8 points per visit. Depression scores remained sub-threshold for 12 months after treatment completion. Resilience scores significantly increased after treatment completion and remained high at all follow up visits through 1 year (p

Individuals on methadone maintenance for the treatment of addiction (MM) are demonstrated to be hyperalgesic to cold-pressor pain in comparison to matched controls and ex-opioid addicts, a finding described as clinical evidence of opioid-induced hyperalgesia (OIH). Interestingly, opioids induce hyperalgesia via many of the same neuro-inflammatory and central sensitization processes that occur with the development of neuropathic pain. Evaluated in this study was the efficacy of a key pharmacotherapy for neuropathic pain, gabapentin (GPN), to reverse OIH in MM patients. Utilizing a clinical trial design and double blind conditions, changes in cold-pressor pain threshold and tolerance following a 5-week trial of GPN (titrated to 2400mg/day) were evaluated at peak and trough methadone plasma levels in a well-characterized MM sample. Drug abstinence was encouraged via an escalating payment schedule, and compliance monitored via pill counts and GPN plasma levels; entered into the analyses were only those subjects compliant and abstinent throughout the study (approximately 45%). Utilizing change scores from baseline, significant improvements in cold-pressor pain threshold and pain tolerance were observed at both peak and trough methadone levels (p

Previously, we showed that neonatal isolation (1-hr isolation/day from dam, litter, and nest on PND 2-9) facilitates cocaine self-administration and increases extracellular dopamine responses in ventral striatum after stimulant administration in adulthood. Recent studies suggest that enduring alterations in neurobehavioral responses associated with early life manipulations reflect changes in maternal behavior. Thus, we sought to determine if neonatal isolation alters maternal care and if dams with neonatal isolation experience as pups showed differential maternal care towards their pups. In Experiment 1, litters were assigned to one of three conditions: neonatal isolation, handled (5-min separation of dam from litter), or non-handled (no separation). Maternal behaviors were rated on PND 2-9 for 60-min immediately following reunion of mother and litter. In Experiment 2, female rats with or without neonatal isolation experience were assigned to either the neonatal isolation or non-handled litter condition and maternal behaviors rated. Dams of isolated and handled litters spent more time licking pups and less time picking up pups to put outside the nest than dams of non-handled litters. Further, dams of isolated and handled vs non-handled litters showed less non-maternal behaviors of burrowing and grooming. Neonatal isolation-experienced dams with isolated litters failed to increase pup-licking and decrease non-maternal behaviors. Rather, these dams picked up pups to place outside the nest more than non-handled-experienced dams. Neonatal isolation alters maternal behavior that, in turn, may shape neurobehavioral responses of offspring including effects on maternal care. Such changes may reflect epigenetic effects resulting from changes in maternal behavior.

Ten-day-old rats were given various tastants to ingest, independent of mother and suckling. Relative to water, the pups ingested significantly more saccharin (0.5%) and NaCl (2.5%) and less quinine (0.4%). Pretreatment with the opiate antagonist, naltrexone, had no effect on water or quinine intake but significantly reduced that of saccharin and NaCl. Furthermore, the preferred solutions of saccharin and NaCl given intraorally caused a decrease in ultrasonic vocalizations of isolated pups and in a separate experiment caused an analgesic response to heat. Both phenomena were reversible with naltrexone administration, suggesting that preferred tastes elicit an endogenous opioid response significantly affecting behaviors seen during isolation.

Publisher Summary Early life stress is a risk factor for addiction. To better understand this association, a model in rats is established; neonatal isolation is termed; and its immediate and enduring behavioral, neurochemical, and hormonal effects are examined. In this procedure, pups are removed from the litter, dam, and nest and isolated individually for 1-hour per day on postnatal days 2–9. As adults, the rats exhibit enhanced acquisition, maintenance, and reinstatement of intravenous cocaine self-administration, animal models of addiction. These effects are greater in female rats. Further, estrous stage interactions on the behavioral effects of cocaine are eliminated by neonatal isolation. The mechanisms that may contribute to these effects include alterations in the mesolimbic dopamine system, a region linked to drug reinforcement, and the hypothalamic–pituitary–adrenal axis, a system also associated with self-administration behavior in rats. Neonatal isolation increases extracellular dopamine responses to psychostimulant administrations and enhances stress responsivity. Results from this research approach show its validity as an animal model of early life stress and can be used to inform more effective prevention and treatment approaches for addiction.

We demonstrated that neonatal isolation (ISO) enhances cocaine self-administration in male and female adult rats and alters ventral striatal extracellular levels of serotonin (5-HT) and dopamine (DA) basally or in response to psychostimulants in infant rats. Now, we examine basal 5-HT, DA, and norepinephrine (NE) levels in nucleus accumbens (NAc) using in vivo microdialysis in adult male and female rats with or without ISO experience. NAc shows estrous cycle-dependent effects as do behavioral responses to cocaine. Because our prior work showed ISO eliminated estrous-cycle effects on behavior, we now test separate groups of females in proestrus, estrus, or diestrus stages. Litters were assigned to the ISO (1-h isolation; postnatal days 2-9) or non-handled (NH) condition. During adulthood (postnatal day 70-90), microdialysis probes were implanted and aimed at NAc core. Ten samples were collected over 150-min and measures of 5-HT, DA, and NE were analyzed via HPLC. ISO did not affect 5-HT levels in males. However, ISO modified estrous stage effects on 5-HT. The pattern of 5-HT levels in NH females (higher in diestrus and proestrus vs. estrus) was reversed in ISO females. DA levels were unaffected by ISO, similar to our findings at other ages, and did not differ by gender or estrous stage. None of these factors affected NE levels. Because 5-HT modulates DA and levels of both transmitters are increased by cocaine, this neurochemical effect of ISO may contribute to the ability of ISO to alter the behavioral responses to cocaine as we showed previously.

Previously, we demonstrated that the early life stress of neonatal isolation enhances extracellular dopamine (DA) levels in ventral striatum in response to psychostimulants in infant rats. Yet, neonatal isolation does not alter baseline DA levels. DA levels are affected by serotonin (5-HT) and striatal levels of this transmitter are also enhanced by cocaine. Other early life stresses are reported to alter various 5-HT neural systems. Thus, the purpose of this study is to test whether neonatal isolation alters ventral striatal 5-HT levels at baseline or in response to cocaine. Litters were subjected to neonatal isolation (1-h individual isolation/day on postnatal days 2–9) or to non-handled conditions and pups assigned to one of three cocaine doses (0, 2.5, or 5.0 mg/kg) groups. On postnatal day 10, probes were implanted in the ventral striatum. Dialysate samples obtained over a 60-min baseline period and for 120 min post cocaine injections were assessed for levels of 5-HT and its metabolite, 5-HIAA. ISO decreased ventral striatal 5-HT levels at baseline and after cocaine administration but did not alter 5-HIAA levels. These data add to the literature on the immediate effects of early life stress on 5-HT systems by showing alterations in the ventral striatal system. Because serotonergic effects in this neural area are associated with reward and with emotion and affect regulation, the results of this study suggest that early life stress may be a risk factor for addiction and other psychiatric disorders.

We demonstrated that neonatal isolation (ISO) increases acquisition of cocaine self-administration and alters psychostimulant-induced ventral striatal dopamine and serotonin levels in female rats. Both dopamine and serotonin modulate the behavioral effects of cocaine and these effects can vary across estrous stages. We now test whether ISO modifies the manner in which estrous stage affects the acute behavioral responses to cocaine. Litters were assigned to ISO (1 h/day isolation; post-natal days 2-9) or non-handled (NH) conditions. In Experiment 1, the ability of cocaine (0.3-30 mg/kg; IP) to disrupt schedule-controlled responding for food was assessed in proestrus, estrus, and diestrus stages. Diestrus and proestrus NH females showed increased response rates at low cocaine doses and decreased rates at higher doses relative to baseline. In contrast, estrus NH females showed decreased responding across all doses. ISO eliminated this estrous stage distinction; only decreased responding to high cocaine doses were seen. Yet, estrous cyclicity during food restriction (Experiment 2) did not differ by group. To confirm this ISO effect, proestrus or estrus rats were administered cocaine (0, 5, 10 mg/kg; IP) and activity monitored in Experiment 3. Locomotor activity differed by estrous stage in NH but not ISO rats. Cocaine plasma levels (Experiment 4) at the time of peak behavioral activity did not differ by group or estrous stage. Results extend prior studies to show estrous stage alters the behavioral effects of cocaine. Neonatal isolation eliminates these effects perhaps reflecting alterations in accumbens monoamine levels or the effects of estrogen on this system.