'Snapshot in time': a cross-sectional study exploring stakeholder experiences with environmental scans in health services delivery research.

OBJECTIVE: To describe stakeholder characteristics and perspectives about experiences, challenges and information needs related to the use of environmental scans (ESs). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A web-based survey platform was used to disseminate an online survey to stakeholders who had experience with conducting ESs in a health services delivery context (eg, researchers, policy makers, practitioners). Participants were recruited through purposive and snowball sampling. The survey was disseminated internationally, was available in English and French, and remained open for 6 weeks (15 October to 30 November 2022). ANALYSIS: Descriptive statistics were used to describe the characteristics and experiences of stakeholders. Thematic analysis was used to analyse the open-text questions. RESULTS: Of 47 participants who responded to the survey, 94% were from Canada, 4% from the USA and 2% from Australia. Respondents represented academic institutions (57%), health agency/government (32%) and non-government organisations or agencies (11%). Three themes were identified: (a) having a sense of value and utility; (b) experiencing uncertainty and confusion; and (c) seeking guidance. The data suggest stakeholders found value and utility in ESs and conducted them for varied purposes including to: (a) enhance knowledge, understanding and learning about the current landscape or state of various features of health services delivery (eg, programmes, practices, policies, services, best practices); (b) expose needs, service barriers, challenges, gaps, threats, opportunities; (c) help guide action for planning, policy and programme development; and (d) inform recommendations and decision-making. Stakeholders also experienced conceptual, methodological and practical barriers when conducting ESs, and expressed a need for methodological guidance delivered through published guidelines, checklists and other means. CONCLUSION: ESs have value and utility for addressing health services delivery concerns, but conceptual and methodological challenges exist. Further research is needed to help advance the ES as a distinct design that provides a systematic approach to planning and conducting ESs.

Innovative Programs with Multi-Service Integration for Children and Youth with High Functional Health Needs.

The integration of care services and providers across the health-social-community continuum has helped improve the lives of many children and youth living with complex health conditions. Using environmental scan data, 16 promising multi-service programs were selected and analyzed qualitatively through a deliberative conversation approach. Descriptive data of analyzed programs are presented, as well as the thematic analysis results. An important program strength is its clear founding principles and engagement of patients and families. However, the scale-up of these initiatives remains a challenge unless such programs can be better financed and supported.

A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol.

BACKGROUND: Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families' access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children's and caregivers' acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data. METHODS: In our 2.5-year study, 108 6-17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families' barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive. DISCUSSION: Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition. TRIAL REGISTRATION: This trial was registered prospectively at ClinicalTrials.gov (# NCT05403658 ; first posted: June 3, 2022).

Experiences, Motivations, and Perceived Impact of Participation in a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study.

BACKGROUND: Caregivers of children and youth with complex care needs (CCNs) often require considerable support to ensure the well-being of their families. Social media present an opportunity to better support caregivers through computer-mediated communication for social support. Peer-to-peer (P2P) support groups are a way in which caregivers are accessing needed support; however, the experiences of caregivers who use these groups and the perceived impact that participation has on caregivers of children and youth with CCNs are not known. OBJECTIVE: This study aimed to explore the experiences of caregivers of children and youth with CCNs who use a Facebook-based P2P support group to communicate, understand their motivations to use the group, and investigate its perceived impact on knowledge of programs and services and sense of community belonging among caregivers. METHODS: A qualitative descriptive design was used to explore the experiences and perceived impact of a Facebook-based (Meta Platforms) P2P support group for caregivers of children and youth with CCNs in New Brunswick, Canada. The group was launched on the web in October 2020, during the COVID-19 pandemic, and resulted in 108 caregivers joining the group. A web-based survey was distributed, and semistructured interviews were conducted in February 2021 with a subsample of members. Thematic analysis was used to identify and report patterns related to caregivers' experiences and perceived impacts of participation. RESULTS: A subsample of members in the Facebook group completed the web-based survey (39/108, 36.1%) and interviews (14/108, 12.9%). A total of 5 themes emerged from the interviews: safe space, informational support and direction, web-based connection with peers, impact on knowledge of programs and services, and degree of community belonging. Participants reported joining the group to obtain geography-specific information support and connect with peers. Many participants reported an improvement in their knowledge of programs and services and felt connected to the community; however, the short observation period and diversity among the caregiver population were cited as barriers to community belonging. CONCLUSIONS: Social media present an important opportunity to facilitate the exchange of support between patients and caregivers in an accessible and curated environment. Findings from this study suggest that involvement in web-based, geography-specific P2P support groups can influence perceived knowledge of services and resources and sense of community belonging among caregivers of children and youth with CCNs. Furthermore, this study provides insight into the experiences and motivations of caregivers of children and youth with CCNs who participate in a private social media environment.

Exploring the Use of a Facebook-Based Support Group for Caregivers of Children and Youth With Complex Care Needs: Qualitative Descriptive Study.

BACKGROUND: Caregivers of children and youth with complex care needs (CCN) require substantial support to ensure the well-being of their families. Web-based peer-to-peer (P2P) support groups present an opportunity for caregivers to seek and provide timely informational and emotional support. Despite the widespread use of social media for health-related support across diverse patient and caregiver populations, it is unclear how caregivers of children and youth with CCN use and potentially benefit from these groups. OBJECTIVE: The aim of this study is to explore the use of a web-based P2P support group for caregivers of children and youth with CCN in New Brunswick, Canada, and investigate factors related to its use by members. METHODS: The study sample consisted of individuals who joined a closed Facebook group and an analysis of content published to the group. In phase 1, a Facebook group was developed in consultation with a patient and family advisory council, and members were recruited to the group. Phase 2 of this study consisted of an observation period during which posts and related interactions (ie, likes, loves, and comments) by members were collected. In phase 3, a web-based survey was distributed, and semistructured interviews were conducted with a subsample of group members. Survey and interview data were analyzed using thematic analysis. RESULTS: A total of 108 caregivers joined the Facebook group between October 2020 and March 2021. There were 93 posts with 405 comments and 542 associated interactions (448/542, 82.7% likes and 94/542, 17.3% loves). Of these 93 posts, 37 (40%) were made by group members, and 56 (60%) were made by moderators. Of the 108 members, a subsample of 39 (36.1%) completed a web-based survey, and 14 (13%) participated in the interviews. Content analyses of posts by members revealed that inquiry (17/37, 46%), informational (15/37, 41%), and emotional posts (4/37, 11%) were the most common. Emotional posts received the highest number of interactions (median 24.5). In total, 5 themes emerged from the interviews related to the use of the group and mediating factors of interactions between group members: resource for information, altruistic contribution, varying level of engagement, perceived barriers to and facilitators of group activity, and moderators as contributing members. CONCLUSIONS: These findings demonstrate that caregivers of children and youth with CCN seek geography-specific P2P support groups to meet informational and social support needs. This study contributes to the knowledge on how caregivers use Facebook groups to meet their support needs through moderate and passive engagement.

Use of environmental scans in health services delivery research: a scoping review.

OBJECTIVE: To examine the extent and nature of evidence on the use of the environmental scan (ES) in the health services delivery literature. DESIGN: Scoping review. METHODS: This scoping review followed the five-stage scoping review methodology outlined by Khalil et al. A Peer Review of Electronic Search Strategies was completed. Seven electronic databases and the grey literature were searched. Pairs of researchers independently performed two levels of screening and data extraction. Data were analysed using qualitative content and thematic analysis. RESULTS: Ninety-six studies were included in the scoping review. Researchers conducted ESs for many purposes, the most common being to examine the current state of programmes, services or policies. Recommendations were informed by ESs in 20% of studies. Most common data collection methods were literature review (71%), key informant or semistructured interviews (46%) and surveys (35%). Over half (53%) of the studies used a combination of passive (looking at information eg, literature, policies, guidelines) and active (looking for information eg, surveys, interviews) approaches to data collection. Person sources of data (eg, healthcare stakeholders, community representatives) and non-person sources of data (eg, documents, electronic databases, the web) were drawn on to a similar extent. The thematic analysis of the definitions/descriptions yielded several themes including instrument of discovery, knowledge synthesis, forward-looking and decision making. Research gaps identified included absence of a standard definition, inconsistencies in terminology and lack of guiding frameworks in the health services delivery context. CONCLUSION: ESs were conducted to gather evidence and to help inform decision making on a range of policy and health services delivery issues across the continuum of care. Consistency in terminology, a consensus definition and more guidance on ES design may help provide structure for researchers and other stakeholders, and ultimately advance ES as a methodological approach. A working definition of ES in a health services delivery context is presented.

Programmes to support transitions in care for children and youth with complex care needs and their families: a scoping review protocol.

INTRODUCTION: Children and youth with complex care needs (CCNs) and their families experience many care transitions over their lifespan and are consequently vulnerable to the discontinuity or gaps in care that can occur during these transitions. Transitional care programmes, broadly defined as one or more intervention(s) or service(s) that aim to improve continuity of care, are increasingly being developed to address transitions in care for children and youth with CCNs. However, this literature has not yet been systematically examined at a comprehensive level. The purpose of this scoping review is to map the range of programmes that support transitions in care for children and youth with CCNs and their families during two phases of their lifespan: (1) up to the age of 19 years (not including their transition to adult healthcare) and (2) when transitioning from paediatric to adult healthcare. METHODS AND ANALYSIS: The Joanna Briggs Institute methodology for scoping reviews (ScR) will be used for the proposed scoping review. ScR are a type of knowledge synthesis that are useful for addressing exploratory research questions that aim to map key concepts and types of evidence on a topic and can be used to organise what is known about the phenomena. A preliminary search of PubMed was conducted in December 2018. ETHICS AND DISSEMINATION: Ethical approval is not required where this study is a review of the published and publicly reported literature. The research team's advisory council will develop a research dissemination strategy with goals, target audiences, expertise/leadership, resources and deadlines to maximise project outputs. The end-of-grant activities will be used to raise awareness, promote action and inform future research, policy and practice on this topic.

A concept analysis of children with complex health conditions: implications for research and practice.

BACKGROUND: This concept analysis aimed to clarify the meaning of "children with complex health conditions" and endorse a definition to inform future research, policy, and practice. METHODS: Using Walker and Avant's (2011)'s approach, we refined the search strategy with input from our team, including family representatives. We reviewed the published and grey literature. We also interviewed 84 health, social, and educational stakeholders involved in the care of children with complex health conditions about their use/understanding of the concept. RESULTS: We provided model, borderline, related, and contrary cases for clarification purposes. We identified defining attributes that nuance the concept: (1) conditions and needs' breadth; (2) uniqueness of each child/condition; (3) varying extent of severity over time; 4) developmental age; and (5) uniqueness of each family/context. Antecedents were chronic physical, mental, developmental, and/or behavioural condition(s). There were individual, family, and system consequences, including fragmented services. CONCLUSIONS: Building on previous definitions, we proposed an iteration that acknowledges the conditions' changing trajectories as involving one or more chronic condition(s), regardless of type(s), whose trajectories can change over time, requiring services across sectors/settings, oftentimes resulting in a lower quality of life. A strength of this paper is the integration of the stakeholders'/family's voices into the development of the definition.

Pediatric Patient and Family Advisory Councils: A Guide to Their Development and Ongoing Implementation.

BACKGROUND: Patient and family engagement is increasingly recognized in the care of children with complex health conditions. Through the implementation of Patient and Family Advisory Councils (PFACs), health-care institutions are working to improve patient care by nurturing partnerships among patients/families, managers, and clinicians. Despite the potential for PFACs, empirical research about their implementation remains scarce. OBJECTIVE: To address this gap, this study explored the recruitment, retention, and implementation strategies used by Canadian PFACs. DESIGN: We used a qualitative descriptive design. PARTICIPANTS: We interviewed 10 spokespersons from Canadian PFACs. RESULTS: We found themes within 2 stages of implementation. The first stage, getting PFACs started, included 4 themes: (1) using evolving recruitment methods, (2) preparing for effective participation, (3) ensuring diversity within PFACs, and (4) preparing terms of reference. The second stage involved strategies to support ongoing PFACs implementation and included 1 overall theme: facilitating optimal PFACs participation. The underlying link between themes was that establishing/maintaining PFACs is an ongoing learning curve. CONCLUSION: Our findings have the potential to inform new and existing PFACs.

Patient Navigation as an Approach to Improve the Integration of Care: The Case of NaviCare/SoinsNavi.

Children and youth with complex care needs require more and varied healthcare services than the average population, as well as a high degree of coordinated care. Evidence has shown that these individuals and their families have better outcomes if they have access to integrated care. Patient navigation can serve as a novel approach to improve the integration of care for individuals with complex care needs in an increasingly fragmented system. NaviCare/SoinsNavi is an example of a navigation centre for children and youth with complex care needs, their families, and the care team. This research-based service is aimed at facilitating more convenient and integrated care using a personalized family-centred approach. NaviCare/SoinsNavi employs two patient navigators who work with clients to formulate and prioritize goals based on their unmet needs. The centre serves as a living laboratory, which provides researchers, knowledge users, and clients a real life setting where innovative ideas can be explored, evaluated, modified as needed throughout the research process, and moved into policy in an efficient manner. Patient navigation programs can contribute to decreasing fragmentation, improving access, and promoting integrated care across disciplines, settings, and sectors for individuals across the lifespan.

The use of the environmental scan in health services delivery research: a scoping review protocol.

INTRODUCTION: The environmental scan has been described as an important tool to inform decision-making on policy, planning and programme development in the healthcare sector. Despite the wide adoption of environmental scans, there is no consensus on a working definition within the health services delivery context and methodological guidance on the design and implementation of this approach is lacking in the literature. The objectives of this study are to map the extent, range and nature of evidence that describe the definitions, characteristics, conceptualisations, theoretical underpinnings, study limitations and other features of the environmental scan in the health services delivery literature and to propose a working definition specific to this context. METHODS AND ANALYSIS: This protocol describes a scoping review based on the methodology outlined by Khalil and colleagues. A comprehensive search strategy was developed by experienced health science librarians in consultation with the research team. A Peer Review of Electronic Search Strategies (PRESS) was completed. Two reviewers will independently screen titles, abstracts and full-text articles and select studies meeting the inclusion criteria from seven electronic databases: Academic Search Premier, Canadian Business & Current Affairs (CBCA), CINAHL, ERIC, Embase, MEDLINE and PsycINFO. The grey literature and reference lists of included articles will also be searched. The data will be analysed and presented in tabular format, and will include a descriptive numerical summary as well as a qualitative thematic analysis. ETHICS AND DISSEMINATION: This protocol provides an audit trail for a scoping review that will advance understanding about the environmental scan and its application in the health services delivery context. The review will propose a working definition and will inform future research to explore the development of a conceptual framework in this context. Findings will be disseminated through a peer-reviewed journal and conference presentations. The scoping review does not require ethics approval.

The impact of patient navigation: a scoping review protocol.

REVIEW OBJECTIVE/QUESTION: The objective of this review is to synthesize the evidence on the impact of patient navigation for all populations across all settings. The question of this review is: What is the existing evidence on the impact of patient navigation?

Paediatric patient navigation models of care in Canada: An environmental scan.

OBJECTIVES: (1) To provide other organizations with useful information when implementing paediatric navigation programs and (2) to inform the implementation of a navigation care centre in New Brunswick for children with complex health conditions. METHODS: This environmental scan consisted of a literature review of published and grey literature for paediatric patient navigation programs across Canada. Additional programs were found following discussions with program coordinators and navigators. Interviews were conducted with key staff from each program and included questions related to patient condition; target population and location; method delivery; navigator background; and navigator roles. Data analysis included analysis of interviews and identification of common themes across the different programs. RESULTS: We interviewed staff from 19 paediatric navigation programs across Canada. Programs varied across a number of different themes, including: condition and disease type, program location (e.g., hospital or clinic), navigator background (e.g., registered nurse or peer/lay navigator) and method of delivery (e.g., phone or face-to-face). Overall, navigator roles are similar across all programs, including advocacy, education, support and assistance in accessing resources from both within and outside the health care system. DISCUSSION: This scan offers a road map of Canadian paediatric navigation programs. Knowledge learned from this scan will inform stakeholders who are either involved in the delivery of paediatric patient navigation programs or planning to implement such a program. Specifically, our scan informed the development of a navigation centre for children with complex health conditions in New Brunswick.

The impact of mindfulness on leadership effectiveness in a health care setting: a pilot study.

PURPOSE: The purpose of this paper is to examine the impact of mindfulness awareness practice (MAP) on mid-level health-care managers' leadership. DESIGN/METHODOLOGY/APPROACH: In total, 11 mid-level health-care managers in eastern Canada took part in an intensive weekend retreat and a follow-up webinar on mindfulness awareness. Perceived stress and leadership effectiveness were assessed pre- and post-intervention (i.e. four and eight weeks). A control group (n=10) also completed the same measures twice. Additionally, informants (n=28) provided assessments of participants' leadership pre- and post-intervention. Follow-up interviews were carried out with eight participants 12-16 weeks post-intervention. FINDINGS: In comparison to controls, retreat participants showed significant increases in mindfulness and corresponding decreases in stress that were sustained across eight weeks post-retreat; retreat participants reported significant positive changes in their leadership effectiveness that were corroborated by informants. Qualitative data, however, suggest that sustaining a mindfulness practice presents significant challenges to middle managers in a health care setting. RESEARCH LIMITATIONS/IMPLICATIONS: The findings are useful to management working in health services that are plagued by increasing demands and changes. Despite the small sample and lack of random assignment, the pilot data support the efficacy of MAP in improving leadership. ORIGINALITY/VALUE: Little empirical research supports the claim that MAP enhances leadership. The present study employed a mixed methods approach to address this gap and demonstrates the potential benefits of MAP among mid-level managers.

Approaches to salivary cortisol collection and analysis in infants.

Salivary cortisol is becoming more commonly utilized as a biologic marker of stress in observational studies and intervention research. However, its use with infants (12 months of age or younger) is less widespread and poses some special challenges to researchers. In order to decide on the most suitable collection procedure for salivary cortisol in infants, a number of criteria should be considered. This article will aid investigators interested in integrating salivary cortisol measurement into their research studies by presenting (1) an overview of the patterns of cortisol secretion in infancy including the development of diurnal rhythm and response to stress; (2) a comparison of the most commonly used approaches for collecting salivary cortisol samples in infants including cotton rope, syringe aspiration technique, filter paper, hydrocellulose microsponge, and the Salimetrics children's swab; (3) a discussion of the factors contributing to heightened cortisol variability in infancy and how these can be limited; (4) analytical issues associated with cortisol measurement; and (5) examples of criteria to consider when choosing a saliva sampling method and lab for conducting assays.

Mild depressive symptoms are associated with elevated C-reactive protein and proinflammatory cytokine levels during early to midgestation: a prospective pilot study.

BACKGROUND: We examined depressive symptoms, C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels during early to-midgestation. METHODS: We measured depressive symptoms on the Patient Health Questionnaire-9 (PHQ-9), and serum CRP, IL-6, and TNF-α levels twice in 27 pregnant women. RESULTS: After adjustment, depressive symptoms prospectively (ß=0.42, p<0.05 at 16-20 weeks of gestation) and concurrently (ß=0.54, p<0.01 at 7-10 weeks of gestation) predicted elevated CRP [F (2, 14)=9.20, p=0.003, R(2)=0.57 and F (3, 15)=9.08, p=0.001, R(2)=0.64, respectively]. There were similar patterns of results for TNF-α (ß=0.72, p<0.01) and IL-6 levels (ß=0.39, p<0.05) at 7-10 weeks of gestation [F (2,19)=8.84, p=0.002, R(2)=0.48]. Furthermore, the association between depressive symptoms at 7-10 weeks of gestation and increased IL-6 levels at 16-20 weeks of gestation approached statistical significance. We confirmed the findings with the Wilcoxon signed rank test (IL-6: Z=2.44, p=0.015; TNF-α: Z=1.94, p=0.05; CRP: approached statistical significance). CONCLUSIONS: These pilot data suggest that depressive symptoms may be associated with inflammatory markers during early to-midgestation.

Listening to the heart-brain talk: persistent depressive symptoms are associated with hsCRP in apparently healthy individuals at high risk for coronary artery disease.

BACKGROUND: This study examined whether mild-to-moderate depressive symptoms are associated with increased high-sensitivity C-reactive protein (hsCRP) and interleukin 6 (IL-6) levels in apparently healthy individuals at high risk for coronary artery disease. We investigated in individuals whether: (1) current depressive symptoms were associated with increased hsCRP and IL-6 levels; (2) persistent depressive symptoms at two time points 6 months apart were associated with hsCRP and IL-6; and (3), sex-based differences in inflammation were a function of depressive symptoms. METHODS: We measured depressive symptoms (twice), hsCRP, and IL-6 (follow-up time point) in 84 apparently healthy individuals (52% women) at high cardiac risk. RESULTS: Patients with persistent depressive symptoms had higher hsCRP, compared to participants without persistent symptoms (5.55 vs. 1.70 mg/l, p < 0.05, 95% CI 0.11 to 1.09, d = 0.67). Participants with current depressive symptoms had higher hsCRP (3.99 vs. 1.70 mg/l, p = 0.059) than those without symptoms. Findings remained unchanged after controlling for covariates. Women had higher adjusted hsCRP than men (2.91 vs. 1.87 mg/l, p < 0.001). When we entered depressive symptoms, the model remained significant, with a significant interaction between sex and symptoms: women with depressive symptoms had higher hsCRP than men with depressive symptoms and than women without symptoms (6.75 vs. 1.11 mg/l). The hypothesized differences were not observed with respect to IL-6, after controlling for body mass index (95% CI-0.77 to 0.73). CONCLUSIONS: Before a first ischaemic coronary event, persistent mild-to-moderate depressive symptoms were associated with increased hsCRP. Women with depressive symptoms had higher hsCRP than men with symptoms.

Elevated salivary C-reactive protein levels are associated with active and passive smoking in healthy youth: A pilot study.

BACKGROUND: We examined salivary C-reactive protein (CRP) levels in the context of tobacco smoke exposure (TSE) in healthy youth. We hypothesized that there would be a dose-response relationship between TSE status and salivary CRP levels. METHODS: This work is a pilot study (N = 45) for a larger investigation in which we aim to validate salivary CRP against serum CRP, the gold standard measurement of low-grade inflammation. Participants were healthy youth with no self-reported periodontal disease, no objectively measured obesity/adiposity, and no clinical depression, based on the Beck Depression Inventory (BDI-II). We assessed tobacco smoking and confirmed smoking status (non-smoking, passive smoking, and active smoking) with salivary cotinine measurement. We measured salivary CRP by the ELISA method. We controlled for several potential confounders. RESULTS: We found evidence for the existence of a dose-response relationship between the TSE status and salivary CRP levels. CONCLUSIONS: Our preliminary findings indicate that salivary CRP seems to have a similar relation to TSE as its widely used serum (systemic inflammatory) biomarker counterpart.

Prenatal tobacco exposure and cortisol levels in infants of teen mothers.

AIMS: prenatal tobacco exposure (PTE) is an important public health concern for the offspring of teen mothers. We examined whether PTE is associated with baseline cortisol levels in four-month-old infants of teenage mothers. METHODS: we assessed salivary cortisol levels of 212 infants. PTE was measured by using self-reports of cigarette smoking during pregnancy. We used a propensity scores matching analysis to compare infants with PTE and those without. RESULTS: of 212 mothers, 151 smoked during pregnancy. However, there was no association between PTE and infant cortisol levels. CONCLUSIONS: we could not support a relation between PTE and cortisol levels in a sample of four-month-old infants of teenage mothers.

The association of major depression, conduct disorder, and maternal overcontrol with a failure to show a cortisol buffered response in 4-month-old infants of teenage mothers.

BACKGROUND: Adolescent pregnancy can be associated with major depression (MD) and conduct disorder (CD). Some infants of adolescent mothers are prenatally exposed to these factors, which may result in heightened risk for perturbations of their stress systems. Between 2 and 4 months, a normal shift occurs in the adrenocortical system in which we observe a marked decrease in infant cortisol response when facing mild stressors. This study aimed to explore whether MD (lifetime, during pregnancy, postpartum), CD, and maternal overcontrol are associated with increased cortisol reactivity in 4-month-old infants of teenage mothers. METHODS: Using arm restraint as a stressor, morning salivary cortisol was taken prestressor and poststressor in 212 infants during a laboratory visit. Major depression and CD were measured with the computerized National Institute of Mental Health Diagnostic Interview Schedule (NIMH-DIS), postpartum depressive mood was measured with the Edinburgh Postnatal Depression Scale, and overcontrol was observed with the CARE-Index. RESULTS: Independent of the predictors, there was a dampened cortisol response. Infants of mothers with lifetime MD and of average to highly overcontrolling mothers showed increased cortisol reactivity. Conduct disorder and cortisol levels were not associated. CONCLUSIONS: Future studies should detect whether the absence of a dampened cortisol response in infants whose mothers have lifetime MD or display overcontrolling parenting is stable over time.