No abstract

Recent findings suggest that elevated stress levels during the pre- and postpartum period are related to poor maternal and infant health outcomes; yet, few studies have prospectively examined the efficacy of stress management interventions on regulating stress levels among mothers and their infants. The current study examined whether a prenatal cognitive behavioral stress management (CBSM) intervention would be effective in regulating salivary cortisol (a biological marker of stress) and self-reported stress levels among mothers and their infants at six and 18 months postpartum, relative to two control groups. Our sample was comprised of predominantly Spanish-speaking, low-income women (80%; mean age=25±5 years) who were screened for depression during their second trimester of pregnancy (M = 16±5 weeks of gestation). Women at high risk for depression [i.e., having either a past history of major depression or current elevated symptoms of depression (≥ 16 on CES-D)] were randomized to either a CBSM group (n=24) or a usual care (UC) group (n=33), while a low risk comparison (LRC) group (n=29) was comprised of women not meeting either depression criteria. ANCOVA analyses demonstrated that: 1) infants of women in the CBSM and LRC groups had significantly lower cortisol levels than infants of women in the UC group at six months postpartum (p < .001); and 2) women in the CBSM group had lower cortisol levels than women in the UC group at 18 months postpartum (p < .01). These results suggest that prenatal CBSM interventions may be efficacious in regulating biological markers of stress among mothers and their infants, thereby decreasing their risk for developing health complications over time.

This exploratory study compared objective sleep patterns and sleep-related factors between caregiving and non-caregiving women with sleep impairments, and compared the sleep patterns of the caregivers with their care recipients. Nine women caring for adults with dementia and a comparison sample of 34 non-caregiving women provided three nights of in-home polysomnography (PSG) and self-report questionnaires of sleep quality and physical and emotional well-being. Care recipients' sleep was monitored with actigraphy on the same nights of the caregivers' PSG. Caregivers and non-caregivers' sleep patterns were similar across most PSG-measured parameters. Caregivers perceived more sleep disturbances, but PSG showed minimal differences compared to non-caregivers. Caregivers reported more depressive symptoms, and depression was strongly correlated with longer sleep latency. Caregiver's sleep quantity was highly correlated with the sleep quantity of their care recipient. The results suggest that, in this sample, caregivers' sleep was not significantly different from the non-caregiving women, despite differences in perceptions. Although the sample is small, this exploratory study supports the use of multiple nights of in-home PSG to assess caregiver sleep and provides more data on sleep patterns of female dementia caregivers and their relatives.

No abstract

The implantable cardioverter defibrillator (ICD) provides a survival advantage over antiarrhythmic medications for patients with life-threatening ventricular arrhythmias. However, the effect of ICD therapy on quality-of-life and psychosocial functioning are not as well understood. Health care providers (e.g., physicians, nurses) can serve as a valuable source of information related to these ICD outcomes. The purpose of this study was to investigate health care provider perceptions regarding: (1) the quality-of-life and psychosocial functioning of their ICD recipients, (2) the concerns or problems reported by ICD recipients, and (3) the degree of provider comfort in managing these concerns. The final sample of health care providers (n = 261) rated ICD recipients' global quality-of-life and psychosocial functioning, and specific concerns about health care, lifestyle, special population adjustment, marital and family adjustment, and emotional well-being. With regard to quality-of-life, health care providers reported that the majority of ICD recipients were functioning better (38%) or about the same (47%) than before implantation. However, health care providers reported that 15% of recipients experienced worse quality-of-life postimplantation. Similarly, health care providers indicated that 10%-20% of ICD recipients experienced worse emotional functioning and strained family relationships. Moreover, issues related to driving, dealing with ICD shocks, and depression were the most common ICD recipient concerns. Significant differences were noted between physicians and nurses/other health care professionals on a wide range of psychosocial issues. Health care providers generally reported the most comfort dealing with traditional medical issues (i.e., patient adherence), and the least comfort in managing emotional well-being issues (e.g., depression and anxiety). These results suggest that routine attention to ICD quality-of-life and psychosocial outcomes is indicated for health care providers who care for ICD recipients.