Multisystem physiological reactivity during help-seeking for attachment needs in school-aged children: differences as a function of attachment.

In this study, we sought to expand on what is currently known regarding autonomic nervous system (ANS) reactivity in middle childhood as a function of attachment. ANS activity includes multiple indices - respiratory sinus arrhythmia (RSA) is an index of parasympathetic nervous system activation (PNS) and electrodermal activity (EDA) is an index of sympathetic nervous system activation (SNS). Children (N = 103) completed Child Attachment Interviews and read vignettes describing situations aimed to activate attachment needs (NEED; e.g., getting hurt, which can elicit need for comfort or assistance) and help-seeking (HS; when children experience need and seek comfort from attachment figures), while SNS and PNS reactivity were monitored. Attachment was not associated with children's SNS or PNS reactivity during NEED, but attachment was associated with physiological reactivity during HS: Dismissing attachment was associated with greater SNS activation (higher EDA) and preoccupied attachment with PNS deactivation (lower RSA, greater vagal withdrawal) during HS.

Expulsion from Community Childcare Centers During the COVID-19 Pandemic: A Review of One State's Practices.

Expulsion has been a well-documented practice in early learning centers throughout the United States. The present study attempted to describe expulsion practices in one state's community childcare centers during the COVID-19 pandemic. Surveys from 161 childcare program administrators were analyzed and, overall, expulsion rates appeared to be lower than they were pre-pandemic. No association was found between whether a program closed and reopened or remained open; the presence of a waiting list; if a program readmitted all or some children; factors that influenced which teachers were rehired; training provided to teaching staff; perceived frequency and intensity of challenging behavior; and availability of support for children with challenging behaviors and expulsion decisions. Results of the current study are analyzed and discussed in this article along with the results and how they fit into the literature.

Strategies to Engage Blacks in Sleep Medicine: Lessons Learned from Three Studies Applying Community-Based Participatory Research Principles.

Introduction: Awareness, assessment and treatment of sleep apnea are disproportionately lower among Blacks, compared to other racial/ethnic groups. To address this health disparity gap, communication strategies that connect Blacks to OSA education, detection and treatment adherence interventions are needed. Strategies that engage individuals through communication technologies, community-level social network support, and medical providers in clinical settings are also needed. We present lessons learned from three studies that offer these solutions using a community-engaged research model: The Metabolic Syndrome Outcome Study (MetSO), Peer-enhanced Education to Reduce Sleep Ethnic Disparities (PEERS-ED), and Tailored Approach to Sleep Health Education (TASHE), to capture program effectiveness and lessons learned from project successes and failures. Methods: The methods of OSA community-based programs included the application of an OSA community-engaged research model. This model served as a strategic guideline for effective interventions to engage communities in research and ensure cultural appropriateness in OSA interventions. Focus groups, in-depth interviews and community steering committee meetings were conducted with various stakeholders. Delphi surveys were used to identify high priority diseases and conditions. Community barriers and needs were identified through iterative combinations of surveys and focus group meetings. Stakeholder groups participated in all aspects of our studies, including the development, dissemination and implementation phases, reflecting a bi-directional decision-making process that ensures the interests of both parties were considered. The MetSO, PEERS-ED and TASHE studies were reviewed to understand the effectiveness of the programs and to evaluate lessons learned. Results: MetSO, PEERS-ED and TASHE interventions revealed that community-engaged strategies are successful in enrolling Black populations into clinical trials. The study teams reached nearly 3,000 Blacks at risk of OSA and screened about 2,000 people in sleep apnea studies in New York City. Sleep brochures were distributed to over 10,000 people. Lessons learned from MetSO, PEERS-ED and TASHE interventions revealed that building relationships, establishing trust, identifying a study champion, learning to adjust and providing participant incentives are key strategic elements for successful recruitment and retention of Blacks participations in clinical trials. Conclusion: Strategic application of community-oriented frameworks ensures active community engagement throughout the research process, allowing for greater enrollment of Blacks in clinical studies as well as increased OSA awareness, diagnosis, and treatment.

The impact of short and long sleep duration on instrumental activities of daily living among stroke survivors.

OBJECTIVE: Stroke survivors generally have problems completing instrumental activities of daily living (IADL; eg, preparing meals, chores, taking a bath, and managing finances). However, it is unclear how stroke survivors might stave off IADL issues. Studies indicating that sleep has restorative neurological effects provide potential mechanisms to address issues with IADL. The aim of this study was to ascertain the association between sleep duration (short or long sleep duration) and IADL among stroke survivors and those without a stroke history. METHODS: Data of 486,619 participants were analyzed from the 2000 to 2015 National Health Interview Survey (NHIS), a nationally representative sample. Measures of self-reported stroke, sociodemographic variables, sleep duration, and IADL problems were collected. Binary logistic regression was utilized to analyze the relationship of short (≤6 hours) and long (≥9 hours) sleep duration with limitations to IADL. RESULTS: Of the sample, 3% reported a physician-diagnosed stroke event. The mean age was 45.73 years; 52.7% were female; 77.4% were White; 14.2% were Black; 41.3% were married, 62.7% were employed; 31.1% reported that annual family income was less than $35,000; 87% reported good-to-excellent health; and 29.7% reported short sleep (≤6 hours). Approximately 30% of stroke survivors reported IADL problems, and 34.4% who reported IADL problems were short sleepers. Among stroke survivors, long sleepers were 97% more likely than average sleepers to report IADL problems (OR =1.97, 95% CI =1.71-2.26, P<0.001) adjusting for age, sex, race, marital status, poverty, and health. CONCLUSION: Findings from our study indicate that, among stroke survivors, long sleepers were more likely to report IADL problems compared to average sleepers (7-8 hours). Future studies should investigate other potential mediators such as severity of stroke, medication, comorbidities, level of impairment, and whether improving sleep among stroke survivors may improve IADL.

Association Between Tooth Loss, Body Mass Index, and All-Cause Mortality Among Elderly Patients in Taiwan.

To date, the effect of tooth loss on all-cause mortality among elderly patients with a different weight group has not been assessed. This retrospective cohort study evaluated the data obtained from a government-sponsored, annual physical examination program for elderly citizens residing in Taipei City during 2005 to 2007, and follow-up to December 31, 2010. We recruited 55,651 eligible citizens of Taipei City aged ≥ 65 years, including 29,572 men and 26,079 women, in our study. Their mortality data were ascertained based on the national death files. The number of missing teeth was used as a representative of oral health status. We used multivariate Cox proportional hazards regression analysis to determine the association between tooth loss and all-cause mortality. After adjustment for all confounders, the hazard ratios (HRs) of all-cause mortality in participants with no teeth, 1 to 9 teeth, and 10 to 19 teeth were 1.36 [95% confidence interval (CI): 1.15-1.61], 1.24 (95% CI: 1.08-1.42), and 1.19 (95% CI: 1.09-1.31), respectively, compared with participants with 20 or more teeth. A significant positive correlation of body mass index (BMI) with all-cause mortality was found in underweight and overweight elderly patients and was represented as a U-shaped curve. Subgroup analysis revealed a significant positive correlation in underweight (no teeth: HR = 1.49, 95% CI: 1.21-1.83; 1-9 teeth: HR = 1.23, 95% CI: 1.03-1.47; 10-19 teeth: HR = 1.20, 95% CI: 1.06-1.36) and overweight participants (no teeth: HR = 1.37, 95% CI: 1.05-1.79; 1-9 teeth: HR = 1.27, 95% CI: 1.07-1.52). The number of teeth lost is associated with an increased risk of all-cause mortality, particularly for participants with underweight and overweight.

Accuracy of clinical evaluation of locally advanced breast cancer in patients receiving neoadjuvant chemotherapy.

BACKGROUND: Physical examination (PE), mammography (MG), breast magnetic resonance imaging (MRI), fluorodeoxyglucose positron emission tomography (PET), and pathologic evaluation are used to assess primary breast cancer. To the authors' knowledge, their accuracy has not been well studied in patients receiving neoadjuvant chemotherapy. Accuracies of each modality in tumor and lymph node assessment in patients with T3/T4 tumors receiving neoadjuvant chemotherapy were compared. METHODS: Forty-five patients of a prospective clinical trial studying T3-T4M0 tumors were included. Patients received neoadjuvant chemotherapy: docetaxel/carboplatin with or without trastuzumab before and/or after surgery (depending on HER-2/neu status and randomization). Tumor measurements by PE, MG, and MRI and lymph node status by PE and PET were obtained before and after neoadjuvant chemotherapy. Concordance among different clinical measurements was assessed and compared with the tumor and lymph node staging by pathology. Spearman correlation (r) and root mean square error (RMSE) were used to measure the accuracy of measurements among all modalities and between modalities and pathologic tumor size. RESULTS: Compared with the tumor size measured by PE, MRI was more accurate than MG at baseline (r=0.559, RMSE=35.4% vs r=0.046, RMSE=66.1%). After neoadjuvant chemotherapy, PE correlated better with pathology than MG or MRI (r=0.655, RMSE=88.6% vs r=0.146, RMSE=147.1% and r=0.364, RMSE=92.6%). Axillary lymph node assessment after neoadjuvant chemotherapy demonstrated high specificity but low sensitivity by PET and PE. CONCLUSIONS: Findings suggested that MRI was a more accurate imaging study at baseline for T3/T4 tumor, and PE correlated best with pathology finding. PET and PE both correctly predicted positive axillary lymph nodes but not negative lymph nodes.