Millions of family members and/or friends in the U.S. serve as unpaid caregivers for individuals with chronic conditions, such as cancer. Caregiving for someone undergoing an intense allogeneic hematopoietic stem cell transplant (HSCT) is particularly demanding, with accompanying physical and psychological stress. Increased stress and stress-related symptoms could make it difficult for caregivers to fulfill their roles and could negatively impact the health status and quality of life of themselves and the recipients. Virtual reality (VR) is a promising technology increasingly used for treatment and wellness in various medical settings. There is growing evidence that studies have reported the positive effects of the VR intervention in managing and reducing stress among diverse populations in various clinical scenarios; however, no published studies have focused on family caregivers of patients with cancer. The study aims to assess the feasibility and acceptability of a four-week nature-based VR intervention and to examine the effectiveness of the VR intervention on stress in HSCT caregivers. This study comprises two phases. Phase I of the study will be a single-arm pre-post design focused on assessing the feasibility and acceptability of the VR intervention. Phase II of the study will be a prospective randomized controlled group design to examine the effectiveness of the VR intervention on perceived stress. Adults (≥ 18 years) who serve as primary caregivers for a person who will undergo an allogeneic HSCT will be recruited. Fifteen participants will be enrolled for Phase I and 94 participants for Phase II (Active VR arm N=47; Sham VR arm N=47). The nature-based immersive VR program contains 360° high-definition videos of nature scenes along with nature sounds through a head-mounted display (HMD) for 20 minutes every day for four weeks. Primary outcome is perceived stress measured by the Perceived Stress Scale. Secondary/exploratory outcomes are stress-related symptoms (e.g., fatigue, sleep disturbance) and physiological biomarkers (e.g., cortisol, alpha-amylase). The importance and innovativeness of this study consist of using a first-of-its-kind, immersive VR technology to target stress and investigating the health outcomes assessed by validated objective biomarkers as well as self-report measures of the nature-based intervention in the caregiver population. Clinical trial registration ClinicalTrials.gov , identifier NCT 05909202.
Abstract Introduction Identifying factors predictive of relapse in patients with alcohol use disorder (AUD) is essential to learning how to effectively treat this disorder. Our group previously found that following inpatient treatment, AUD patients with lower sleep regularity were more likely to relapse. The aim of this study is to discern whether circadian rhythm dysregulation is predictive of relapse. Methods A cohort of patients who received inpatient treatment for AUD (n=126) wore Philip Respironics actiwatches following discharge for four weeks. A subset of patients additionally wore the watches during prior discharge from inpatient treatment (n=24). Relapse status was assigned if a patient consumed any alcohol during the outpatient period of data collection. We calculated circadian rhythm nonparametric statistics including interdaily stability (IS) and intradaily variability (IV) for the inpatient and outpatient periods. Linear and logistic generalized mixed models were fit in R to estimate the effect of the inpatient-outpatient transition on circadian behavior, and of weekly circadian parameters on relapse probability. All analyses account for within-patient repeated measurements. Results Final sample size included 103 patients after actigraphy data filters were applied. Patients were 48.6±11.3 years of age and 32% female. Among patients with at least 4 days of inpatient data, IV was on average 0.068 units lower during the first week post-discharge (SE=0.018, F[1,29]=14.92, p< 0.001). By contrast, IS did not substantially change following discharge. Twenty-six patients (25.2%) experienced a relapse event. Relapse at any time during the study was associated with a mean 0.03 unit decrease in IS (SE=0.014, F[1,101]=4.29, p< 0.05), whereas relapse was not associated with a significant shift in IV. Conclusion Our preliminary analyses detected a change in circadian behavior (IV) at discharge, which may be an effect of scheduled activities that cease upon discharge. General alignment to a 24-h cycle, as captured by IS, was not disrupted by discharge. However, IS but not IV exhibited an association with relapse. Additional research on this topic will include clinical patient covariates and time to determine if IV and/or IS are predictive of later relapse and time until relapse. Support (if any) This research was supported by the National Institutes of Health Intramural Research Program.
Sedentary time (ST) and neighborhood environment (NE) are predictors of cardiovascular (CV) health. However, little is known about ST's relationship with NE. We examined associations of perceived and objective NE with ST in the predominantly African American faith-based population of the Washington, D.C. CV Health and Needs Assessment. After using community-based research principles, participants reported NE perceptions, including sidewalks, recreational areas, and crime presence. Factor analysis was conducted to explore pertinent constructs; factor sums were created and combined as Total Perception Score (TPS) (higher score = more favorable perception). Objective NE was assessed using Google Maps and the Active Neighborhood Checklist (ANC). ST was self-reported. Linear regression determined relationships between TPS and ST, and ANC scores and ST, for 1) overall population, 2) lower median-income D.C. areas, and 3) higher median-income DC and Maryland areas. For the sample (N = 98.9% African-American, 78% female), lower median-income areas had significantly lower mean TPS and ANC scores than higher median-income areas (p < 0.001). Three factors (neighborhood violence, physical/social environment, and social cohesion) were associated with overall NE perception. Among those in lower median-income areas, there was a negative association between TPS and ST that remained after covariate adjustment; this was not observed in higher median-income areas. There was no association between ANC scores and ST. Poorer NE perception is associated with greater ST for those in lower income areas, while objective environment is not related to ST. Multi-level interventions are needed to improve NE perceptions in lower-median income areas, reduce ST, and improve CV health.
The aim of this study was to determine the effect of problem-solving education on self-efficacy and distress in informal caregivers of allogeneic hematopoietic stem cell transplantation patients. Patient/caregiver teams attended three 1-hour problem-solving education sessions to help cope with problems during hematopoietic stem cell transplantation. Primary measures included the Cancer Self-Efficacy Scale–transplant and Brief Symptom Inventory–18. Active caregivers reported improvements in self-efficacy ( p < 0.05) and distress ( p < 0.01) post-problem-solving education; caregiver responders also reported better health outcomes such as fatigue. The effect of problem-solving education on self-efficacy and distress in hematopoietic stem cell transplantation caregivers supports its inclusion in future interventions to meet the multifaceted needs of this population.
Introduction: Chronic stress is a cardiovascular disease (CVD) risk factor but the mechanisms by which it promotes CVD are unclear. Chronic stress can affect amygdalar activity (AmygA), leading to increased levels of activity. We evaluated mediators of the relationship between chronic stress-related amygdalar activity (AmygA) and trimethylamine n-oxide (TMAO), a cardiovascular risk marker. Hypothesis: IL-1 β mediates the association between amygdalar activity and TMAO. Methods: 60 African American adults (93% female, mean age 61±11 years) at risk for CVD living in the Washington DC area participated in a cross-sectional, community-focused study. Participants had a 18 FDG PET/CT to assess chronic stress-related AmygA, phenotyping, and ELISA-based techniques to measure serum cytokines and TMAO. Multivariable regression analyses adjusted for atherosclerotic cardiovascular disease (ASCVD) 10-year risk score and body mass index (BMI) identified associations between AmygA and TMAO. IL-1 β, TNF-α, IL-6, IL-8, IL-17 and IFN-γ were evaluated as mediators of indirect associations between AmygA and TMAO. Results: Multivariable regression modeling revealed significant associations between AmygA and TMAO (β=0.32, p=0.02), AmygA and IL-1 β (β=0.36, p=0.003), and IL-1 β and TMAO (β=0.39, p=<0.001) in the fully adjusted model. IL-1 β mediated the AmygA and TMAO relationship (mediation effect = 43.51%). Conclusions: Chronic stress measured by AmygA directly associates with TMAO, a CVD risk biomarker. This relationship is mediated by IL-1 β, suggesting the potential for chronic stress-related inflammation in the brain-gut axis potentially influencing CVD in underserved communities. These hypothesis-generating results should be studied further in the future by including large, diverse populations.
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