Financial Hardship and Sleep Quality Among Black American Women With and Without Systemic Lupus Erythematosus.

OBJECTIVE: To compare dimensions of financial hardship and self-reported sleep quality among Black women with versus without systemic lupus erythematosus (SLE). METHODS: Participants were 402 Black women (50% with validated diagnosis of SLE) living in Georgia between 2017 and 2020. Black women with SLE were recruited from a population-based cohort established in Atlanta, and Black women without SLE were recruited to be of comparable age and from the same geographic areas as SLE women. Financial hardship was measured using three different scales: financial adjustments, financial setbacks, and financial strain. Sleep was assessed continuously using the Pittsburgh Sleep Quality Index (PSQI) scale. Each dimension of financial hardship was analyzed separately in SLE-stratified multivariable linear regression models and adjusted by sociodemographic and health status factors. RESULTS: Dimensions of financial hardship were similarly distributed across the two groups. Sleep quality was worse in Black women with, versus without, SLE (p < .001). Among Black women with SLE, financial adjustment was positively associated with a 0.40-unit increase in poor sleep quality (95% CI = 0.12-0.67, p = .005). When accounting for cognitive depressive symptoms, financial setbacks and strain were somewhat attenuated for Black women with SLE. Overall, no associations between financial hardships and sleep quality were observed for the women without SLE. CONCLUSIONS: Black women with SLE who experience financial hardships may be more at risk for poor sleep quality than Black women without SLE. Economic interventions targeting this population may help improve their overall health and quality of life.

Financial responsibility, financial context, and ambulatory blood pressure in early middle-aged African-American women.

BACKGROUND: African-American women have excess rates of elevated blood pressure (BP) and hypertension compared to women of all other racial/ethnic backgrounds. Several researchers have speculated that race and gender-related socioeconomic status (SES) stressors might play a role. OBJECTIVE: To examine the association between a novel SES-related stressor highly salient among African-American women, financial responsibility for one's household, and 48-h ambulatory BP. We further examined whether aspects related to African-American women's financial context (e.g., single parenthood, household income, marital status) played a role. METHODS: Participants were N = 345 employed, healthy African-American women aged 30-46 from diverse SES backgrounds who underwent 48-h ambulatory BP monitoring. Linear regression analyses were conducted to examine associations between self-reported financial responsibility and daytime and nighttime BP, adjusting for age, SES and other sociodemographics, cardiovascular risk factors, financial strain and depressive symptoms. Interactions between financial responsibility and single parenthood, household income, and marital/partnered status were tested. RESULTS: In age-adjusted analyses, reporting financial responsibility was associated with higher daytime systolic (ß = 4.42, S.E. = 1.36, p = 0.0013), and diastolic (ß = 2.82, S.E. = 0.98, p = 0.004) BP. Associations persisted in fully adjusted models. Significant associations were also observed for nighttime systolic and diastolic BP. There were no significant interactions with single parenthood, household income, nor marital/partnered status. CONCLUSION: Having primary responsibility for one's household may be an important driver of BP in early middle-aged African-American women, independent of SES, financial strain, and across a range of financial contexts. Future studies examining prospective associations are needed, and policy interventions targeting structural factors contributing to financial responsibility in African-American women may be warranted.

The association between Superwoman schema and subjective sleep quality among Black women.

OBJECTIVES: Similar to women overall, Black women are socialized to be communal and "self-sacrificing," but unlike women from other racial/ethnic backgrounds, Black women are also socialized to be "strong" and "invulnerable." This phenomenon is labeled Superwoman schema. This study examined associations between Superwoman schema endorsement and subjective sleep quality. METHODS: Participants included 405 Black women (ages 30-46). Superwoman schema was measured using a 35-item scale capturing five dimensions: obligation to present strength, suppress emotions, resistance to vulnerability, motivation to succeed, and obligation to help others. Superwoman schema overall and the five dimensions/subscales were analyzed. The Pittsburgh Sleep Quality Index (PSQI) was used to investigate overall subjective sleep quality (range: 0-19), poor sleep quality (PSQI >5), and specific sleep domains (eg, sleep duration, sleep disturbances). We fit linear and binary logistic regression models, adjusting for health-related and sociodemographic factors. RESULTS: Superwoman schema dimension obligation to help others was associated with lower overall subjective sleep quality (ß: .81, 95%CI=0.29, 1.32) and poor sleep quality (OR: 1.55, 95%CI=1.10, 2.19), as well as bad subjective sleep quality (OR: 1.76, 95%CI=1.18, 2.66), sleep disturbances (ß: .73, 95%CI =0.07, 1.41), and daytime sleepiness (OR: 2.01, 95%CI=1.25, 3.26). Suppress emotions (OR: 1.41, 95%CI=1.01, 1.99) was associated with poor subjective sleep quality. Superwoman schema overall was associated with daytime sleepiness (OR: 2.01, 95%CI=1.06, 3.82). CONCLUSION: Superwoman schema endorsement, especially obligation to help others and suppress emotions, may be important psychosocial risk factors for Black women's sleep health.

Age moderates change in disease-related stress among congenital heart disease survivors: a 6-year follow-up.

AIMS: As congenital heart disease (CHD) survivors age, they are confronted with elevated risk of cardiovascular morbidity and increasingly complex disease self-management demands. Given that stress is associated with poor physical and psychosocial outcomes, it is crucial to examine how disease-related stress changes over time in this population. However, this outcome has received little research attention to date. This study aimed to identify demographic and clinical predictors of change in disease-related stress over 6 years among CHD survivors. METHODS AND RESULTS: Congenital heart disease survivors (N = 252, Mage = 25.6 ± 7.1, 52.9% female) completed the first 13 items of the Responses to Stress Questionnaire, adapted for use among CHD survivors, to assess disease-related stressors at study entry (T1) and 6-year follow-up (T2). Age, gender, estimated family income, and New York Heart Association (NYHA) functional class at T1 were entered into mixed linear models to determine their impact on change in disease-related stress. Older age (P < 0.001), lower income (P < 0.001), and presence of functional limitations (NYHA ≥ II) (P < 0.001) predicted greater increases in disease-related stress. When controlling for NYHA, functional class, and income, a significant time by age interaction was identified such that disease-related stress increased over time among those who were adolescents at T1 [b = 4.20, P = 0.010, 95% confidence interval (1.01, 7.40)], but remained stable among young adults. CONCLUSION: The transition from adolescence to adulthood may be a period of increasing disease-related stress. Healthcare providers should consider screening adolescents for elevated disease-related stress during transition education and provide resources to bolster resilience.

Superwoman Schema and self-rated health in black women: Is socioeconomic status a moderator?

BACKGROUND: The Superwoman Schema (SWS) construct elucidates Black women's socialization to be strong, suppress their emotions, resist vulnerability, succeed despite limited resources, and help others at their own expense. Drawing from intersectionality and social psychological research on self-schemas, this study examined the extent to which SWS was associated with Black women's self-rated health. We also investigated whether socioeconomic status (SES) moderated the association between SWS, its five dimensions, and self-rated health. METHODS: Data were from the Mechanisms Underlying Stress and Emotions (MUSE) in African-American Women's Health Study, a cohort of African American self-identified women. SWS was assessed using Giscombé's 35-item Superwoman Schema Scale. Socioeconomic status was measured by household income and educational attainment. Ordered logistic regression models were used and statistical interactions were run to test for moderation (N = 408). RESULTS: First, SWS dimension "obligation to help others" was associated with worse self-rated health (p < .05). Second, household income, but not education, moderated the association between SWS and self-rated health (p < .05): SWS overall was associated with worse self-rated health among higher income women but better self-rated health among lower income women. Third, income moderated the association between SWS dimension "obligation to present an image of strength" and self-rated health (p < .05): presenting strength was associated with better self-rated health for lower income women only. Fourth, moderation results revealed that SWS dimension "obligation to help others" was inversely associated with self-rated health particularly among higher income women. CONCLUSIONS: Findings speak to the complex interplay between SES and SWS dimensions as they relate to Black women's perceived health.

Psychosocial Outcomes in Children with Cleft Lip and/or Palate: Associations of Demographic, Cleft Morphologic, and Treatment-Related Variables.

OBJECTIVE: To determine associations of demographic, morphologic, and treatment protocol parameters with quality of life (QoL), appearance/speech satisfaction, and psychological adjustment. DESIGN: Observational study utilizing retrospective report of protocol variables and current outcome variables. SETTING: Six North American cleft treatment clinics. PARTICIPANTS: Children, ages 8.0-10.99 years, with Cleft Lip ± Alveolus, Cleft Palate, Cleft Lip and Palate, and parents (N = 284). OUTCOME MEASURES: Pediatric QoL Inventory (PedsQL): Parent, Child, Family Impact Module (FIM); Patient Reported Outcome Measurement Information System (PROMIS); Child Behavior Checklist (CBCL); CLEFT-Q. RESULTS: Outcome scores were average with few differences by cleft type. Multiple regression analyses yielded significant associations (Ps < .05) between socioeconomic status, race, and age at assessment and parent- and self-reported measures. Females had higher PROMIS Depression (ß=.20) but lower CBCL Affective (ß = -.16) and PROMIS Stigma scores (ß= -.24). Incomplete cleft lip was associated with lower PROMIS Depression, and more positive ratings of CLEFT-Q: Nose, Nostril, Lip Scar; CBCL Competence scores, (ßs = -.17 to .17). Younger Age at Lip Closure was associated with higher CBCL School Competence (ß= -.18). Younger Age at Palate Closure was associated with higher Child PedsQL Total, Physical, Psychosocial QoL, and better CLEFT-Q Speech Function (ßs = -.18 to -.15). Furlow Palatoplasty was associated with more CBCL Externalizing Problems (ß = .17) higher CBCL Activities (ß = .16). For all diagnoses, fewer Total Cleft-Related Surgeries was associated with lower PROMIS Stigma and higher CBCL Total Competence and Activities (ßs = -.16 to .15). CONCLUSIONS: Demographic characteristics, lip morphology, and treatment variables are related to later psychological functioning.

VR-based cognitive rehabilitation for children with traumatic brain injuries: Feasibility and safety.

PURPOSE/OBJECTIVE: Traumatic brain injury (TBI) is a leading cause of acquired disability in children, who are at risk of significant impairment in executive function (EF). Virtual reality technology provides a novel strategy to offer rich and immersive training content that is both appealing to children and of potential value in improving their daily functioning. The present study aimed to evaluate the feasibility and safety of implementing an innovative VR-based interactive cognitive training (VICT) system for EF rehabilitation designed to meet the developmental and clinical needs of children with TBI. RESEARCH METHOD/DESIGN: A parallel-group random-block randomized controlled trial was conducted among 26 children 7-17 years with TBI, who completed baseline, postintervention, and 2-month follow-up visits. Feasibility was assessed for recruiting children, measuring outcomes, and implementing the intervention. VR satisfaction was assessed via 5-point Likert scales. Safety outcomes included simulator sickness (0-4) and physical exertion (6-20). Preliminary efficacy was assessed by NIH Toolbox Cognitive Battery tasks. RESULTS: Findings supported the feasibility of recruitment, outcome assessment, and delivery of the intervention. The intervention group reported adequate VR satisfaction in terms of pleasure (M = 3.25, SD = .50) and motivation (M = 2.75, SD = .96), as well as low levels of physical exertion (M = 6.25, SD = .50) and simulator sickness (M = .16, SD = .19). Preliminary evidence supported potential efficacy of the intervention, particularly for moderate and severe TBIs. CONCLUSION/IMPLICATIONS: The present study found high feasibility, safety, and preliminary efficacy of the VICT system. Further research is required to fully examine the intervention's efficacy as a possible rehabilitation tool for children with TBI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

School Readiness in 4-Year-Old Very Preterm Children.

The aims of this study were to identify the aspects of school readiness that best distinguish very preterm (VPT) preschoolers from full-term (FT) controls, determine the extent to which readiness problems in the VPT group reflected global cognitive weaknesses or more specific deficits, and identify distinct profiles of readiness problems. Fifty-three VPT (gestational age ≤ 30 weeks) 4-year-olds were compared to 38 FT (gestational age ≥ 37 weeks) controls on measures of global cognitive ability, executive function, motor skills, early literacy and numeracy, and psychosocial functioning. Latent class analysis (LCA) was also conducted to identify individual readiness profiles. The VPT group had the most pronounced difficulties on tests of spatial and nonverbal cognitive abilities, executive function, motor skills, phonological processing, and numeracy. The VPT group also had sex-related difficulties in processing speed, social functioning, and emotion regulation. These differences were evident in analyses of both continuous scores and rates of deficits. The VPT group's difficulties in motor skills, and VPT females' difficulties in social functioning and emotion regulation, were evident even when controlling for global cognitive ability. LCA suggested four profiles of readiness, with the majority of the VPT group assigned to profiles characterized by relative weaknesses in either cognitive abilities or psychosocial functioning or by more global readiness problems. The findings support the need to evaluate multiple aspects of school readiness in VPT preschoolers and inform efforts to design more targeted early educational interventions.

Randomized Controlled Trial of Omega-3 and -6 Fatty Acid Supplementation to Reduce Inflammatory Markers in Children with Autism Spectrum Disorder.

This double-blind, randomized controlled trial, tested fatty acid (FA) supplementation in children (ages 2- < 6 years) recently diagnosed with Autism Spectrum Disorder (ASD). Participants received daily oral FA supplement containing omega-3 and omega-6 FA, or a placebo for 90 days based on participant weight. Erythrocyte FAs and the cytokines, IL-1ß, IL-2, IFNγ, were measured in plasma obtained from serial blood collections. Treatment increased omega-3 and omega-6 FA levels (1.40 mol% for EPA and 1.62 mol% for DHA) and reduced IL-2 levels compared to placebo (- 0.17 pg/mL, 95% CI - 0.31, - 0.02, d = - 0.62). Omega 3-6 treatment was tolerable and adherence was greater than 70%. Future research will assess the effects of Omega 3-6 treatment on ASD symptoms. Registered on 06/08/2018 with ClinicalTrials.gov: NCT03550209.

Family functioning buffers the consequences of the COVID-19 pandemic for children's quality of life and loneliness.

COVID-19 resulted in mass quarantine measures early in the pandemic. This disruption of daily life widened inequities and made children one of the most vulnerable populations during the crisis. This national, cross-sectional "COVID-Kids" study collected data from almost 500 parent-child dyads using standardized measures to better understand the effects of COVID exposure and impact on children's quality of life and loneliness. Data were collected via social media from May to July 2020. According to parent proxy and child self-report, United States children experienced worse quality of life (p < 0.0001; d = 0.45 and 0.53) and greater child-reported loneliness (p < 0.0001) when compared to normative, healthy samples (i.e., children who do not have a chronic medical condition). Older children (r = 0.16, p = 0.001) and female children (r = 0.11, p = 0.02) reported greater loneliness. Higher child-reported family functioning scores were associated with better quality of life (r = 0.36, p < 0.0001) and less loneliness (r = -0.49, p < 0.0001). Moderated mediation analyses indicated the indirect effect of parent COVID impact on the association between COVID exposure and child quality of life was weaker in the context of better family functioning. Results of this study raise concern for the short-and long-term sequelae of the pandemic on the physical and mental health of children. Healthcare providers and researchers must find new and innovative ways to protect the well-being of children. Strengthening family functioning may buffer the effects of the pandemic and improve overall quality of life in our "COVID Kids."

Impact of a multi-level intervention, Sundara Grama, on latrine use and safe disposal of child faeces in rural Odisha, India

Odisha state has one of the lowest rates of sanitation coverage in India. According to the 2015-2016 India National Family Health Survey, coverage was only 23 per cent in rural areas. The sanitation context of rural Puri district, the location of this research, was better than the overall context of the state, with 36.8 per cent of households having an improved sanitation facility.