Hair Cortisol Concentration, Perceived Stress, Mental Well-Being, and Cardiovascular Health in African American Older Adults: A Pilot Study.

(1) Background: African Americans experience high rates of psychological stress and hypertension, which increases their risk of cardiovascular disease with age. Easy-to-collect psychological and biological stress data are valuable to investigations of this association. Hair cortisol concentration (HCC), as a proxy biomarker of chronic stress exposure, provides such advantages in contrast to collection of multiple daily samples of saliva. Objective: To examine the relationships among HCC, perceived stress, mental well-being, and cardiovascular health (systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)). (2) Methods: Cross-sectional secondary data (N = 25) were used from a mind-body intervention study in hypertensive African Americans ages 65 and older. Data included HCC, a four-item perceived stress scale, SF-36 mental components summary, and SBP/DBP. SBP + 2 (DBP)/3 was used to calculate MAP. (3) Results: The relationship between mental well-being and perceived stress (r = -0.497, p ≤ 0.01) and mental well-being and DBP (r = -0.458, p = 0.02) were significant. HCC change was not significant. In a regression model, every unit increase in well-being predicted a 0.42 decrease in DBP (ß = -0.42, 95% CI (-0.69-0.15)) and a 1.10 unit decrease in MAP (ß = -1.10, 95% CI (-1.99-0.20)). (4) Conclusions: This study contributes to the knowledge of physiologic data regarding the relationship between MAP and well-being. Findings from this study may aid in the development of interventions that address mental well-being and cardiovascular health in African American older adults with hypertension.

Co-created health education intervention among older African American women living with hypertension.

INTRODUCTION: African Americans over the age of 60 years face disproportionate risk of developing hypertension, which can be mitigated with lifestyle changes. This study examines the acceptability and cost of a patient-centered, co-created health education intervention with older African Americans living with hypertension. METHODS: Twenty women participated in this study that included four weekly, two-hour group sessions centered on hypertension knowledge and calibration of home blood pressure monitors, stress and interpersonal relationship management, sleep and pain management, and healthy eating. The study took place in the Midwest United States. RESULTS: Descriptive statistics were used to analyze acceptability data that included attendance and a brief investigator-generated questionnaire. Twenty women were enrolled. Sixteen participants attended all four sessions, all reported they intended to continue using the intervention and felt it fit within their culture, routine, and self-care practices. The estimated cost of conducting the intervention was $227.00 (U.S. dollars) per participant. CONCLUSIONS: The co-created health education intervention was acceptable. Given the dire need for cost-effective interventions to improve the adoption of health promoting self-care management behavior, to reduce the prevalence of hypertension in African Americans, the results of this study have implications for future research and practice.

Work-related Musculoskeletal Disorders Among Radiographers: An Exploration of Self-reported Symptoms.

PURPOSE: To explore self-reported musculoskeletal symptoms in radiographers registered by the American Registry of Radiologic Technologists (ARRT) in the United States. There is a gap in the literature focusing on the unique set of risk factors for radiographers. METHODS: A subset of ARRT radiographers received an email invitation to complete an online survey that included questions about their experience with musculoskeletal symptoms and their exposure to potential risk factors for those symptoms. RESULTS: Out of the 635 ARRT credentialed, nonretired radiographers who completed the survey, 81% reported experiencing pain or discomfort while performing patient cases. Through logistic regression statistical modeling, a set of 4 personal factors (including poorer perceptions of health and sleep quality), 1 work demographic factor (working in fluoroscopy), and 3 psychosocial work factors (including perceptions of higher physically demanding workload and work pressure and stress) were identified in differentiating radiographers who experience pain or discomfort when performing patient cases from those who do not. DISCUSSION: Consistent with prior research, these results indicate multiple work-related factors, including physical and psychosocial work factors, appear to be associated with the prevalence of musculoskeletal symptoms in radiographers. Ideas for addressing these risk factors are discussed, as well as opportunities for radiography managers and academics to collaborate in evaluating the effectiveness of intervention ideas when deployed in practice. CONCLUSION: Although this study is cross-sectional, these results can be used to inform intervention efforts, such as limiting or rotating work duties in fluoroscopy, reducing other physically demanding aspects of work, addressing understaffing, which increases work pressure in many ways, and promoting employee self-care practices.

The Necessary Thread of Mindfulness Intervention Fidelity Assurance: Enabling an Organizational Strategy to Promote Health Care Professional Well-Being.

PURPOSE: A growing waitlist for Mindfulness in Motion (MIM), an evidence-based worksite mindfulness-based intervention, necessitated a training system with built in fidelity assurance to meet program demand. MIM was delivered as part of an organizational strategy in a large academic health center to enhance Health Care Professional (HCP) well-being. In order to ensure that the intervention was being delivered the same way to each cohort, a process to ensure intervention fidelity was developed for MIM. METHOD: The core components of MIM informed the development of a detailed fidelity monitoring system to ensure consistent intervention delivery. Each MIM cohort was conducted with both trained facilitators and trained intervention fidelity monitors. RESULTS: Across 11 cohort offerings of MIM, each 8 weeks in length, there was a mean adherence rate of 0.9886, SD = 0.0012. CONCLUSION: The fidelity monitoring system allowed for a reliable expansion of MIM offerings to HCPs and for a seamless pivot to fully virtual MIM delivery, necessitated by COVID-19.

Deep Relaxation Experience with Complementary Urban Zen Integrative Therapy: Qualitative Thematic Analysis.

Complementary Health Approaches (CHAs) are used as adjunctive therapy for managing symptoms associated with chronic conditions. Little evidence exists about how patients with pulmonary hypertension use or experience CHA. We explored patients' relaxation experience during Urban Zen Integrative Therapy (UZIT) and present qualitative thematic analysis results of 32 focused-debriefing-interviews. Thirteen community-dwelling adults received six individual weekly sessions that included essential oil, gentle-body movement, restorative pose, body-awareness meditation, and Reiki. Two themes, "Relaxation" and "In-between state," were subjected to dimensional analysis and detailed description. We identified conditions or phenomena contributing to these themes across the following contextual sub-categories: time/temporal, associated elements, what the experience felt like, and asleep state. Deep relaxation experience was achieved when participants lost the sense of time, primarily during body-awareness meditation, and while they were "drifting" into an asleep state. These elements provide clarity for the future development of therapeutic endpoints of patients' experience of CHA.ClinicalTrial.gov # NCT03194438.

Mindfulness in Motion and Dietary Approaches to Stop Hypertension (DASH) in Hypertensive African Americans.

OBJECTIVES: Hypertension increases the risk of developing Alzheimer's disease or related dementias. This pilot study's purpose was to examine the feasibility and acceptability of a novel intervention, Mindfulness in Motion (MIM) and Dietary Approaches to Stop Hypertension DASH (MIM DASH), to improve diet, mindfulness, stress, and systolic blood pressure (BP) in older African Americans with mild cognitive impairment (MCI) and hypertension. DESIGN: Cluster randomized controlled trial. SETTING: Intergenerational community center in a large metropolitan area. PARTICIPANTS: African Americans with MCI and hypertension. Participants were divided into six groups randomized 1:1:1 to the MIM DASH group, attention only (non-hypertensive education) group, or true control group. The MIM DASH and attention only interventions were delivered in 8-weekly 2 hour group sessions. MIM included mindful movements from chair/standing, breathing exercises, and guided meditation. The DASH component used a critical thinking approach of problem solving, goal setting, reflection, and self-efficacy. The true control group received a DASH pamphlet at the end. MEASUREMENTS: Feasibility was tracked through enrollment and attendance records; acceptability was assessed through interviews. Blood pressure was measured using the Omron HEM-907XL Monitor. Dietary intake was measured by DASH-Q. Mindfulness was measured by the Cognitive and Affective Mindfulness Scale. Stress was measured by the Perceived Stress Scale. MCI was determined using the Self-Administered Gerocognitive Examination. Data were collected at baseline and 3-months. RESULTS: Median session attendance was six for the MIM DASH group and six for the attention only group. There were no changes in diet, mindfulness, or stress. There was a clinically significant reduction in systolic BP in the MIM DASH group (-7.2 mmHg) relative to the attention only group (-.7), and no change between the MIM DASH and true control groups. CONCLUSION: Results indicate that the MIM DASH intervention was feasible and culturally acceptable in African Americans with hypertension and MCI.

Embracing Change: A Mindful Medical Center Meets COVID-19.

BACKGROUND: Healthcare professional (HCP) burnout transcends clinician job title and role, thus creating a need for interprofessional strategies to address burnout. The organizational framework of offering employer-sponsored mindfulness programming to HCPs sets the stage for an orchestrated, mindful response to COVID-19. OBJECTIVE: This single arm pre-post interventional research tested changes in measures of burnout, resilience, perceived stress and work engagement for interprofessional HCP faculty and students participating in Mindfulness in Motion (MIM), a novel eight-week multimodal evidenced-based onsite intervention. METHODS: A Graduate Medical Education (GME) pilot of MIM was expanded to target inter-professional resiliency within an academic health center. MIM is the core offering of the Gabbe Health and Wellness program for students, staff, faculty, and residents and is embedded across the entire medical center. RESULTS: The faculty/student role demographic categories (n = 267) included resident physicians, resident chaplains, attending physicians, medical center faculty, and hospital administrative/managerial clinical staff. These cohorts demonstrated significant 27% reduction in participants meeting burnout criteria. Total burnout was determined by scores on subscales of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) of the Maslach Burnout Inventory (MBI). There was a highly significant pre/post decrease in the in the emotional exhaustion (p < 0.00001) and depersonalization scores (p < 0.001), with highly significant increase in the personal accomplishment (p < 0.00001) scores. Resilience, as measured by the Connor Davidson Resiliency Scale (CDRS), significantly increased (p < 0.00001), alongside a significant increase (p < 0.00001) in the total Utrecht Work Engagement Score (UWES) and a significant decrease in scores on the Perceived Stress Scale (PSS) (p < 0.00001). CONCLUSION: MIM significantly reduced burnout and perceived stress, for interprofessional (HCP) faculty and staff, while increasing resilience and work engagement in a large healthcare system. These results paved the way for an organizational response that utilized mindfulness to empower HCPs to navigate through the novel challenges presented by COVID-19.

The Impact of Urban Zen Integrative Therapy on Symptoms and Health-Related Quality of Life for Patients with Pulmonary Hypertension.

Background: Patients with pulmonary hypertension (PH) experience distressing symptoms that can undermine quality of life (QoL) and treatment adherence. Complementary health approaches are known to help manage symptoms of chronic conditions and may have therapeutic benefits in PH. Objective: To explore the impact of Urban Zen Integrative Therapy (UZIT) on PH-related symptoms. Design: A within-subjects, pre-/post-intervention, repeated-measures design. Subjects/Setting: Community-dwelling adults with PH received weekly UZIT sessions in an outpatient setting. Measurements: Participants (n = 14) rated symptoms before and after each session and before and after the six-week UZIT program. Mixed-effects modeling with repeated measures was used to estimate differences in mean symptom scores before and after individual sessions. Cohen's d effect sizes were used to evaluate the impact of the UZIT program on symptoms. Results: Mean scores for pain (F(1, 105) = 19.99, p < 0.001), anxiety (F(1, 96) = 24.64, p < 0.001), fatigue (F(1, 120) = 15.68, p < 0.001), and dyspnea (F(1, 68) = 16.69, p < 0.001) were significantly reduced after UZIT sessions. Effects were moderate to large for symptom severity (d = 0.59-1.32) and moderate for symptom burden (d = 0.56) and fatigue (d = 0.62), and small for QoL (d = 0.33) after the six-week UZIT program. Conclusions: Individualized UZIT sessions were associated with reductions in symptom severity for pain, anxiety, fatigue, and dyspnea. The six-week UZIT program was associated with improvements in symptom burden, activity limitation, and QoL. ClinicalTrial.gov no.: NCT03194438.

Intervention fidelity monitoring of Urban Zen Integrative Therapy (UZIT) for persons with pulmonary hypertension.

BACKGROUND: Systematic and consistent dose delivery is critical in intervention research. Few studies testing complementary health approach (CHA) interventions describe intervention fidelity monitoring (IFM) and measurement. OBJECTIVE: To describe methodological processes in establishing and measuring consistent dose, delivery, and duration of a multi-component CHA intervention. METHODS: Adults with pulmonary hypertension received six weekly, 1-hour Urban Zen Integrative Therapy (UZIT) sessions. A total of 78 sessions were delivered and 33% of these sessions were audited. Intervention dose (time allocated to each component), intervention consistency (protocol adherence audits), and intervention delivery (performance and sequence of components) were captured using remote video observation and review of the recorded video. IFM audits were performed at the beginning (n = 16), middle (n = 5), and end (n = 5) of the study. RESULTS: UZIT interventionists adhered to the intervention protocol (99.3%) throughout the study period. Interventionists delivered UZIT components within the prescribed timeframe: 1) Beginning: gentle body movement (18.9 ± 5.8 min.), restorative pose with guided body awareness meditation (21.3 ± 2.7 min.), and Reiki (22.8 ± 3.1 min.); 2) Middle: gentle body movement (15.9 ± 1.5 min.), pose/body awareness meditation (30.1 ± 6.5 min.), and Reiki (30.1 ± 7.0 min.); 3) End: gentle body movement (18.1 ± 3.6 min.), pose/body awareness meditation (35.3 ± 6.4 min.), and Reiki (34.5 ± 7.0 min.). Essential oil inhalation was delivered during UZIT sessions 100% of the time. Interventionists adhered to treatment delivery behaviors throughout the study period: beginning (98.86%), middle (100%), and end (100%). DISCUSSION: In this pilot study, we demonstrated that the dose, consistency, and delivery of multi-component CHA therapy can be standardized and monitored to ensure intervention fidelity.

Recruiting Endometrial Cancer Survivors to Studies Examining Lifestyle Behaviors and Quality of Life: Challenges Faced and Lessons Learned.

There are a growing number of cancer survivors in the USA. Despite lifestyle behaviors being strongly associated with morbidity and mortality following primary treatment, recruitment to clinical research studies that aim to improve such behaviors remains a significant challenge. Furthermore, pilot and feasibility studies are critical for the refinement of research methods and form an important training opportunity for early career scientists. This report details the challenges faced and lessons learned in the process of recruiting a population of overweight/obese endometrial cancer survivors (ECS) to two separate studies focused on lifestyle behaviors: a survey study and a randomized behavioral intervention study that aimed to improve diet, physical activity, and quality of life. We used in-clinic and mail-based approaches to reach eligible patients identified from clinic records. Surveys were offered via paper or online. To evaluate the recruitment process, we compared clinic records and enrollment data over time and location. Chi-squared tests were also used to compare recruitment strategies. We address specific challenges at the patient level, the clinic/provider level, and the organizational level. Overall response rate was 13.9% to the survey and 4% to the intervention. Responses to in-clinic offers were greater than to mail-based approaches for the survey with no difference for the intervention. Identifying the unique characteristics of each survivorship population, adequate planning, resource allocation, and involvement of key staff are essential to supporting recruitment efforts to research studies. Having the support of physicians and nurses is especially critical to the success of recruitment.

Mindfulness in Motion for People with Multiple Sclerosis: A Feasibility Study.

BACKGROUND: Mindfulness in Motion is an 8-week mindfulness-based intervention that uses yoga movement, mindfulness meditation, and relaxing music. This study examined the feasibility of using Mindfulness in Motion in people with multiple sclerosis (MS) and the effect of this program on stress, anxiety, depression, fatigue, and quality of life in people with MS. METHODS: Twenty-two people with MS completed the 8-week mindfulness program as well as assessments 1 week before and after the intervention. RESULTS: Pre/post comparison of four self-reported questionnaires-the Mental Health Inventory, 36-item Short Form Health Status Survey, Modified Fatigue Impact Scale, and Five Facet Mindfulness Questionnaire-showed significant improvement in physical functioning, vitality, and mental health. Specifically, improvements were seen in anxiety, depression, and positive affect; cognitive, psychosocial, and overall functioning regarding fatigue; and mindfulness in the areas of observing, acting with awareness, nonjudgment, and nonreactivity. CONCLUSIONS: Due to the uncertainty in disease progression associated with MS, and the multiplicity of mental and physical symptoms associated with it, programming that addresses anxiety, depression, and fatigue is a key area of future research in MS disease management. Mindfulness in Motion proved to be a feasible program yielding positive results, supporting the need for research to determine the extent to which the program can improve quality-of-life outcomes for people with MS.

A Pragmatic Introduction of Mindfulness in a Continuing Education Setting: Exploring Personal Experience, Bridging to Professional Practice.

CONTEXT: Continuing Medical Education and Continuing Professional Education (CME/CPE) provide a context through which to introduce practicing Healthcare Professionals (HCPs) to emerging mind/body approaches. OBJECTIVE: To introduce mindfulness to practicing HCPs for application in their practice through an experiential CME/CPE session. DESIGN: This descriptive study included surveys administered in the context of a CME/CPE session at professional meetings, as well as a three-month follow-up survey. SETTING: The mindfulness session was administered at 5 state-wide professional CME/CPE meetings throughout Ohio. PARTICIPANTS: Participants practicing dieticians, nurses, psychologists, and smoking cessation educators, among others. INTERVENTION: A brief experiential introduction to mindfulness and the potential application within healthcare. MEASURES: These included participant's prior awareness and use of Complementary and Alternative Medicine (CAM) techniques, and subsequent likelihood of investigating these modalities further for personal and professional use. RESULTS: 64.4% of HCPs had used CAM for personal use and 49.3% had used CAM in their clinical practice, while 74.8% of HCPs had been asked by patients about CAM and 84.3% of the HCPs perceived a need for more education on CAM.94.79% of respondents reported likeliness to investigate mindfulness for personal use and 92.58% for professional use. CONCLUSION: A brief mindfulness intervention for HCPs utilizing a CME/CPE mechanism is a feasible and effective way to introduce HCPs to a mind/body therapy such as mindfulness. CME/CPE instruction ensures that the information provided is in line with evidenced based practice and an experiential component of the instruction demonstrates for the HCP an appropriate use of CAM with patients.

A Mindfulness-Based Lifestyle Intervention for Obese, Inactive Endometrial Cancer Survivors: A Feasibility Study.

BACKGROUND: Mindfulness-based interventions (MBIs) to address self-regulation and lifestyle behaviors (diet, physical activity) may benefit endometrial cancer survivors (ECS), who are at increased risk for morbidity and mortality associated with obesity. However, the acceptability of mindfulness training and whether it can augment behavior change in ECS is unknown. We aimed to examine; 1) the feasibility of the Mindfulness in Motion + Diet (MIM+D) intervention and 2) the preliminary efficacy of MIM+D for improving mindfulness, diet, PA and health-related quality of life (HRQL). METHODS: ECS (Mage=62.4, ±5yrs from diagnosis) completed assessments at baseline, 8 and 14 weeks. Feasibility was determined by intervention completion surveys, attendance and adherence data. We used repeated measures ANOVA's (SPSS 22.0) and effect size estimates (Cohen's d) to examine changes in mindfulness, diet, PA, and HRQL over time. RESULTS: Thirteen ECS (76%) completed the MIM+D program and attendance (≥6/8 sessions) was 90%. Women reported favorably on the overall quality (mean of 4.75/5) and benefits of the MIM+D program; however, would have preferred receiving MIM+D closer to diagnosis. Intention to treat analyses found MIM+D did not significantly improve any outcomes. However, an intervention completers analysis showed significant change in mindfulness (p=.0039) and small to moderate estimates for change in fruits and vegetable intake (d=.23), MVPA (d=.45), RAND SF-36: MCS (d=.46), and sleep quality (d=.68). CONCLUSIONS: Integrating mindfulness training into behavioral interventions is feasible and ECS that adhere to these lifestyle programs may benefit. However, to future research should examine the-long term effects of mindfulness-based behavioral lifestyle interventions.

A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention.

OBJECTIVE: To compare healthcare costs and utilization among participants in a study of two active lifestyle interventions implemented in the workplace and designed to foster awareness of and attention to health with a propensity score matched control group. DESIGN AND SETTING: We retrospectively compared changes in healthcare (HC) utilization among participants in the mindfulness intervention (n=84) and the diet/exercise intervention (n=86) to a retrospectively matched control group (n=258) drawn for this study. The control group was matched from the non-participant population on age, gender, relative risk score, and HC expenditures in the 9 month preceding the study. MAIN OUTCOME MEASURES: Measures included number of primary care visits, number and cost of pharmacy prescriptions, number of hospital admissions, and overall healthcare costs tracked for 5 years after the intervention. RESULTS: Significantly fewer primary care visits (p<.001) for both intervention groups as compared to controls, with a non-significant trend towards lower overall HC utilization (4,300.00 actual dollar differences) and hospital admissions for the intervention groups after five years. Pharmacy costs and number of prescriptions were significantly higher for the two intervention groups compared to controls over the five years (p<0.05), yet still resulted in less HC utilization costs, potentially indicating greater self-management of care. CONCLUSION: This study provides valuable information as to the cost savings and value of providing workplace lifestyle interventions that focus on awareness of one's body and health. Health economic studies validate the scale of personal and organization health cost savings that such programs can generate.

Perceived stress predicts allergy flares.

BACKGROUND: A relation between stress and symptoms of rhinitis has not been established. OBJECTIVE: To determine if participants' reporting of allergy flares correlated with perceived emotional stress, depression, mood, and a biomarker of stress (cortisol). METHODS: This study was a secondary analysis of 179 university employees who participated in a study evaluating the influence of several lifestyle interventions on health symptoms and inflammation. Perceived stress and depressive symptom questionnaires were obtained before each 2-week study period. Online diary entries documenting same-day allergy flares, stressful events, perceived stress, mood, and salivary cortisol levels were collected daily during 2 14-day blocks. RESULTS: Thirty-nine percent of subjects (n = 69) self-reported allergy symptoms. This allergy flare group had higher perceived stress scores than the group without allergy symptoms. Perceived stress, but not depressive symptoms, positively correlated with allergy flares evaluated during 2 independent 14-day periods. There also was a positive relation between negative mood scores and allergy flares over the course of the study. Cortisol had no association with allergy symptom flares. CONCLUSION: These findings suggest that individuals with persistent emotional stress have more frequent allergy flares. Furthermore, those with more flares have greater negative mood.

Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults.

Mindfulness-based stress reduction (MBSR) has produced behavioral, psychological, and physiological benefits, but these programs typically require a substantial time commitment from the participants. This study assessed the effects of a shortened (low-dose [ld]) work-site MBSR intervention (MBSR-ld) on indicators of stress in healthy working adults to determine if results similar to those obtained in traditional MBSR could be demonstrated. Participants were randomized into MBSR-ld and wait-list control groups. Self-reported perceived stress, sleep quality, and mindfulness were measured at the beginning and end of the 6-week intervention. Salivary cortisol was assessed weekly. Significant reductions in perceived stress (p = .0025) and increases in mindfulness (p = .0149) were obtained for only the MBSR-ld group (n = 22). Scores on the global measure of sleep improved for the MBSR-ld group (p = .0018) as well as for the control group (p = .0072; n = 20). Implications and future research are discussed.