Nature-based virtual reality intervention to manage stress in family caregivers of allogeneic hematopoietic stem cell transplant recipients: a two-phase pilot study protocol.

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 NCT05909202.

Going virtual during the COVID-19 pandemic: adaptation of a mixed-methods dietary behavior study within a community-based participatory research study of African-American adults at risk for cardiovascular disease.

BACKGROUND: Identifying mechanisms to maintain CBPR studies during an infectious disease pandemic is vital. The current paper describes the changes in methods and processes conducted within a CBPR mixed-methods study to a virtual setting during the novel coronavirus (COVID-19) pandemic. METHOD: The DC Community Organizing for Optimal Culinary Knowledge study with Heart (DC COOKS with Heart) was designed to assess the feasibility of a dietary behavior intervention among African-American adults that are at risk for cardiovascular disease (CVD). The study is under the umbrella of an ongoing CBPR study and community advisory board that facilitates community involvement in study design and promotes ongoing engagement with community members and leaders. The study population for D.C. COOKS with Heart consists of adult African-American individuals who live in two low-resource neighborhoods in Washington, D.C., which were impacted disproportionately by COVID. Eligible study participants who previously participated in the DC CHOC community-based studies were contacted to participate in Phase 1. The quantitative part of the mixed-methods included survey data collection. RESULTS: Due to the pandemic, the mode of data collection for surveys changed from self-administered face-to-face to internet-based. All virtual study procedures were conducted between March and April, 2021. Anticipated benefits of the virtual setting included participant safety during the pandemic, ease of logistics for participants. Anticipated challenges included administration of electronic devices to participants, research team training, and potential threats to established trust related to the privacy and confidentiality of participants. CONCLUSION: The transition to a virtual setting for study procedures in a mixed-methods study was conducted successfully in terms of recruitment, retention of participants, and training of research team members. The virtual transition required established and ongoing engagement through the community advisory board and CBPR practices, institutional support through virtual research policies, collaborations with information technology-based teams, and equipment administration for the study. TRIALS REGISTRATION: NCT04305431 . Registered on March 12, 2020.

Dietary Intakes of Patients with Alcohol Use Disorder During a 4-Week Protocol on an Inpatient Treatment Unit Found to Meet Dietary Reference Intakes for Macronutrients, but Have Variability in Energy Balance and Adequacy of Micronutrient Intake.

BACKGROUND: Despite literature supporting the importance of diet during rehabilitation, minimal research quantifies dietary intake during treatment for alcohol use disorder (AUD). OBJECTIVE: The aim was to quantify dietary intake and energy balance of patients with AUD during inpatient treatment. DESIGN: This was a secondary analysis of data from a 4-week observational protocol. Participants self-selected food from a room service menu. Dietary intake was recorded by patients and reviewed by nutrition staff. To quantify nutrient and food group intake, data were coded into Nutrition Data Systems for Research software, versions 2016 and 2017. Daily average intake was calculated for all dietary variables. PARTICIPANTS/SETTING: Participants (n = 22) were adults seeking treatment for AUD at the National Institutes of Health Clinical Center (Bethesda, MD) between September 2016 and September 2017 and who were enrolled in a study examining the microbiome during AUD rehabilitation. Four participants discontinued protocol participation before study week 4 and were not included in analyses examining change over time. MAIN OUTCOME MEASURES: Weight change, daily energy, and macronutrient and select micronutrient intakes were the main outcome measures included. STATISTICAL ANALYSES PERFORMED: Mean differences in intake and weight were assessed using nonparametric tests. RESULTS: Sixty-four percent of participants were male; mean ± SD age was 46.3 ± 13.0 years, mean ± SD body mass index (calculated as kg/m2) was 23.9 ± 2.5, and mean intake was 2,665 kcal/d (consisting of 45.9% carbohydrate, 34.9% fat, and 19.1% protein). Eighty percent or more of this sample met the Estimated Average Requirement for 10 of 16 micronutrients assessed. Male participants consumed more energy than estimated needs (P = .003) and gained a mean ± SD of 2.67 ± 1.84 kg (P = .006) when an outlier with weight loss and acute pancreatitis was removed from analysis. Female participants did not gain weight or consume more than estimated energy needs. CONCLUSIONS: Overall macronutrient intake was within recommended ranges, but intake of other dietary components and weight gain were variable, supporting the need for individualized nutrition care during AUD treatment.

Sleep-Related Cognitive/Behavioral Predictors of Sleep Quality and Relapse in Individuals with Alcohol Use Disorder.

BACKGROUND: Little is known about cognitive and behavioral predictors of sleep quality and relapse among individuals with alcohol use disorder (AUD). Using the social cognitive theory (SCT), we assessed sleep-related behaviors and cognitions, sleep quality, and relapse to drinking among individuals with AUD transitioning from inpatient to outpatient settings. METHOD: Individuals (n = 149) seeking treatment for AUD were recruited during their inpatient stay. Self-efficacy for sleep, dysfunctional beliefs about sleep, sleep-related behaviors, sleep quality, and relapse were assessed. Objective (actigraphy) assessment of sleep efficiency and duration was measured using actigraphy. Multiple logistic regression models tested whether self-reported sleep quality or sleep-related beliefs/behavior predicted relapse. Repeated measures linear mixed modeling tested whether there was a change over time in sleep quality as well as the relationships between self-efficacy, sleep-related beliefs, sleep behaviors, sleep quality, and relapse. RESULTS: In our sample, self-efficacy for sleep, dysfunctional beliefs about sleep, and sleep-related behavior were all significantly associated with both sleep quality and relapse. Controlling for pre-discharge sleep-related behaviors (SRBQ) and actigraphy-recorded average sleep time during the first week post-discharge, married participants had lower odds of relapse compared with non-married patients (p = 0.048, OR = 0.119, 95% CI 0.015-0.983). Patients with lower self-efficacy for sleep (SES) scores (p < 0.001) and higher CPRS anxiety scores (p < 0.001) had higher PSQI scores. CONCLUSION: Our results highlight the importance of self-efficacy and dysfunctional beliefs about sleep as predictors of sleep quality and relapse among individuals with AUD and the utility of the SCT as a sleep research framework.

Longitudinal gut microbiome changes in alcohol use disorder are influenced by abstinence and drinking quantity.

Many patients with alcohol use disorder (AUD) consume alcohol chronically and in large amounts that alter intestinal microbiota, damage the gastrointestinal tract, and thereby injure other organs via malabsorption and intestinal inflammation. We hypothesized that alcohol consumption and subsequent abstinence would change the gut microbiome in adults admitted to a treatment program. Stool and oral specimens, diet data, gastrointestinal assessment scores, anxiety, depression measures and drinking amounts were collected longitudinally for up to 4 weeks in 22 newly abstinent inpatients with AUD who were dichotomized as less heavy drinkers (LHD, <10 drinks/d) and very heavy drinkers (VHD, 10 or more drinks/d). Next-generation 16 S rRNA gene sequencing was performed to measure the gut and oral microbiome at up to ten time points/subject and LHD and VHD were compared for change in principal components, Shannon diversity index and specific genera. The first three principal components explained 46.7% of the variance in gut microbiome diversity across time and all study subjects, indicating the change in gut microbiome following abstinence. The first time point was an outlier in three-dimensional principal component space versus all other time points. The gut microbiota in LHD and VHD were significantly dissimilar in change from day 1 to day 5 (p = .03) and from day 1 to week 3 (p = .02). The VHD drinking group displayed greater change from baseline. The Shannon diversity index of the gut microbiome changed significantly during abstinence in five participants. In both groups, the Shannon diversity was lower in the oral microbiome than gut. Ten total genera were shared between oral and stool in the AUD participants. These data were compared with healthy controls from the Human Microbiome Project to investigate the concept of a core microbiome. Rapid changes in gut microbiome following abstinence from alcohol suggest resilience of the gut microbiome in AUD and reflects the benefits of refraining from the highest levels of alcohol and potential benefits of abstinence.

Adults with alcohol use disorder may overreport dietary intake using the 1-year Diet History Questionnaire II.

Minimal recent research explores how alcohol use disorder (AUD) affects dietary intake during periods of alcohol consumption. Therefore, we aimed to assess the feasibility and utility of a computerized food frequency questionnaire, the Diet History Questionnaire II (DHQ II), to quantify dietary intake in adults with AUD. Participants were adult men and women seeking treatment for AUD at the National Institutes of Health Clinical Center. Participants (N = 21) were enrolled in an observational study examining the microbiome in AUD. The Web-based DHQ II, reflecting dietary intake over the past year, was administered to participants within 2 weeks of admission to an inpatient alcohol rehabilitation program. Descriptive data are reported as mean ±â€¯SEM. Analyses were run in the Statistical Package for the Social Sciences, and P < .05 was considered significant. Participants (67% male) were 46.3 ±â€¯2.8 years old with a body mass index of 23.8 ±â€¯0.6 kg/m2. Average energy intake was 27961.7 ±â€¯3205.8 kj, alcohol intake was 4723.0 ±â€¯75.8 g (45% kcal), carbohydrate intake was 514.3 ±â€¯66.8 g (31% kcal), fat intake was 101.2 ±â€¯13.6 g (16% kcal), and protein intake was 122.8 ±â€¯17.0 g (8% kcal). In this population of adults with AUD, DHQ II results showed energy and micronutrient intakes that were higher than, but macronutrient distribution that was similar to, previous findings in similar populations.