Secondary outcomes of a behavioral sleep intervention: A randomized clinical trial.

OBJECTIVE: Nearly 80% of cancer patients struggle with insomnia, which is associated with decreased heart rate variability (HRV) and quality of life (QOL). The aim of this secondary analysis was to evaluate the possible effects of Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI), delivered during chemotherapy visits, on QOL and HRV in patients with breast cancer (BC). METHOD: QOL and HRV data were obtained during a pilot clinical trial assessing the feasibility and effects of BBT-CI on insomnia. A total of 71 BC patients (mean age = 52.5 years) were randomly assigned to either BBT-CI or a healthy-eating control intervention (HEAL). BBT-CI and HEAL were delivered over 6 weeks (2 face-to-face sessions plus 4 phone calls) by trained staff at 4 National Cancer Institute-funded Community Oncology Research Program clinics. QOL was measured with the Functional Assessment of Cancer Therapy (FACT-G) and HRV with the Firstbeat device at baseline and after intervention. RESULTS: There were significant improvements in QOL after intervention for BBT-CI (FACT-G, p = .009; FACT-B, p = .016; ANCOVA) and 5-min supine HRV measures (SDNN, p = .005; rMSSD, p = .004; HF, p = .009; ANCOVA) compared with HEAL. CONCLUSIONS: Patients randomized to BBT-CI showed improvements in QOL and HRV, providing support for BBT-CI's possible benefit when delivered in the community oncology setting by trained staff. A more definitive efficacy trial of BBT-CI is currently being planned with sufficient statistical power to evaluate the intervention's clinical utility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Feasibility and acceptability of brief behavioral therapy for cancer-related insomnia: effects on insomnia and circadian rhythm during chemotherapy: a phase II randomised multicentre controlled trial.

BACKGROUND: This phase II RCT was conducted to determine the feasibility and acceptability of brief behavioral therapy for cancer-related insomnia (BBT-CI) in breast cancer patients undergoing chemotherapy. We also assessed the preliminary effects of BBT-CI on insomnia and circadian rhythm in comparison to a Healthy Eating Education Learning control condition (HEAL). METHODS: Of the 71 participants recruited, 34 were randomised to receive BBT-CI and 37 to receive HEAL. Oncology staff was trained to deliver the intervention in four community clinics affiliated with the NCI. Insomnia was assessed with the Insomnia Severity Index (ISI), and circadian rhythm was assessed using a wrist-worn actiwatch. RESULTS: Community staff interveners delivered 72% of the intervention components, with a recruitment rate of 77% and an adherence rate of 73%, meeting acceptability and feasibility benchmarks. Those randomised to BBT-CI improved their ISI scores by 6.3 points compared to a 2.5-point improvement in those randomised to HEAL (P = 0.041). Actigraphy data indicated that circadian functioning improved in the BBT-CI arm as compared to the HEAL arm at post-intervention (all P-values <0.05). CONCLUSIONS: BBT-CI is an acceptable and feasible intervention that can be delivered directly in the community oncology setting by trained staff. The BBT-CI arm experienced significant improvements in insomnia and circadian rhythm as compared to the control condition.

Heart Rate Variability Markers as Correlates of Survival in Recipients of Hematopoietic Cell Transplantation

OBJECTIVES: To assess pre-/post-transplantation changes in autonomic tone, as measured by heart rate variability (HRV), among patients undergoing hematopoietic cell transplantation (HCT) and to look at those changes as they relate to post-transplantation survival rates. 
. SAMPLE & SETTING: Data were derived from a sample of 27 English-speaking patients undergoing allogeneic or autologous HCT at Stanford University. 
. METHODS & VARIABLES: A survival analysis using the Kaplan-Meier estimator was employed to explore whether increased HRV would enhance survival probabilities over time among patients undergoing HCT.
. RESULTS: An increased probability of survival was significantly related to increases in two HRV indexes. IMPLICATIONS FOR NURSING: HRV may be a useful predictor of mortality among patients undergoing HCT. Interventions deliverable by nurses could be used to enhance HRV for patients identified as being at risk for early mortality.

Management of side effects during and post-treatment in breast cancer survivors.

Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are commonly experienced symptoms that share psychological and physical manifestations. One or more of these symptoms will affect nearly all patients at some point during their course of treatment or survivorship. These side effects are burdensome and reduce patients' quality of life well beyond their cancer diagnosis and associated care treatments. Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are likely to have multiple etiologies that make it difficult to identify the most effective method to manage them. In this review, we summarized the information on cancer-related fatigue, insomnia, and cancer-related cognitive impairment incidence and prevalence among breast cancer patients and survivors as well as recent research findings on pharmaceutical, psychological, and exercise interventions that have shown effectiveness in the treatment of these side effects. Our review revealed that most current pharmaceutical interventions tend to ameliorate symptoms only temporarily without addressing the underlying causes. Exercise and behavioral interventions are consistently more effective at managing chronic symptoms and possibly address an underlying etiology. Future research is needed to investigate effective interventions that can be delivered directly in clinic to a large portion of patients and survivors.

Effects of childhood trauma exposure and cortisol levels on cognitive functioning among breast cancer survivors.

Cognitive functioning difficultiesin breast cancer patients receiving chemotherapy are common, but not all women experience these impairments. Exposure to childhood trauma may impair cognitive functioning following chemotherapy, and these impairments may be mediated by dysregulation of hypothalamic-pituitary-adrenal (HPA) axis function and cortisol slope. This study evaluated the association between childhood trauma exposure, cortisol, and cognition in a sample of breast cancer survivors. 56 women completed measures of trauma exposure (the Traumatic Events Survey), salivary cortisol, and self-reported cognitive functioning (the Functional Assessment of Cancer Therapy - Cognitive). We examined correlations between childhood trauma exposure and cognitive functioning, then used linear regression to control for factors associated with cognition (age, education, time since chemotherapy, depression, anxiety, and insomnia), and the MacArthur approach to test whether cortisol levels mediated the relationship between trauma and cognitive functioning. 57.1% of the sample had experienced at least one traumatic event in childhood, with 19.6% of the sample witnessing a serious injury, 17.9% experiencing physical abuse, and 14.3% experiencing sexual abuse. Childhood trauma exposure and cognitive functioning were moderately associated (r=-0.29). This association remained even when controlling for other factors associated with cognition; the final model explained 47% of the variance in cognitive functioning. The association between childhood trauma and cognitive functioning was mediated by steeper cortisol slope (partial r=0.35, p=0.02). Childhood trauma exposure is associated with self-reported cognitive functioning among breast cancer survivors and is mediated by cortisol dysregulation. Trauma should be considered, among other factors, in programs aiming to address cognition in this population.

Does the KABC-II Display Ethnic Bias in the Prediction of Reading, Math, and Writing in Elementary School Through High School?

This study explored whether the Kaufman Assessment Battery for Children-Second Edition (KABC-II) predicted academic achievement outcomes of the Kaufman Test of Educational Achievement-Second Edition (KTEA-II) equally well across a representative sample of African American, Hispanic, and Caucasian school-aged children ( N = 2,001) in three grade groups (1-4, 5-8, 9-12). It was of interest to study possible prediction bias in the slope and intercept of the five underlying Cattell-Horn-Carroll (CHC) cognitive factors of the KABC-II-Sequential/Gsm (Short-Term Memory), Learning/Glr (Long-Term Storage and Retrieval), Simultaneous/Gv (Visual Processing), Planning/Gf (Fluid Reasoning), and Knowledge/Gc (Crystallized Ability)-in estimating reading, writing, and math. Structural equation modeling techniques demonstrated a lack of bias in the slopes; however, four of the five CHC indexes showed a persistent overprediction of the minority groups' achievement in the intercept. The overprediction is likely attributable to institutional or societal contributions, which limit the students' ability to achieve to their fullest potential.

How Much Does WAIS-IV Perceptual Reasoning Decline Across the 20 to 90-Year Lifespan When Processing Speed is Controlled?

The most prominent pattern of cognitive change over the lifespan centers on the difference between patterns of maintained abilities on tests of crystallized knowledge and patterns of steady decline on tests of problem solving and processing speed. Whereas the maintained-vulnerable dichotomy is well established in the literature, questions remain about cognitive decline in problem solving when processing speed is controlled. This relationship has been examined in cross-sectional studies that typically used non-clinical tests with non-representative samples of adults. This study extended these findings to the most popular clinical test, the Wechsler Adult Intelligence Scale -4th ed. (WAIS-IV), using its carefully stratified sample as the source of data (ages 20-90 for Indexes, ages 16-90 for Perceptual Reasoning subtests). Multivariate Analysis of Covariance (MANCOVA) revealed that 70-80% of the variance in declining reasoning ability was shared with the speed factor. This was true (a) on the index and subtest level and (b) regardless of the type of problem-solving task employed. Such robust findings have important clinical and research implications for neuropsychologists, who most frequently use the Wechsler scales as part of their assessment battery.

Personally Meaningful Rituals: A Way to Increase Compassion and Decrease Burnout among Hospice Staff and Volunteers.

BACKGROUND: Rituals can increase a sense of connectedness, meaning, and support, especially after the death of those for whom we care. Hospice staff may benefit from the use of personal rituals as they cope with the frequent deaths of their patients, ultimately aiming to provide compassionate care while minimizing burnout. OBJECTIVE: This study investigated the role of personally meaningful rituals in increasing compassion and decreasing burnout among hospice staff and volunteers. DESIGN AND MEASUREMENTS: An online survey was completed by members of the National Hospice and Palliative Care Organization (NHPCO) which inquired about personal ritual practices, and included the Professional Quality of Life (ProQOL) scale to measure current levels of Compassion Satisfaction, Burnout, and Secondary Traumatic Stress. SETTING/SUBJECTS: Three hundred ninety hospice staff and volunteers from across 38 states completed the online survey. The majority of participants were Caucasian and female, with an average of nine years of experience in hospice and palliative care. RESULTS: The majority of hospice staff and volunteers used personally meaningful rituals after the death of their patients to help them cope (71%). Those who used rituals demonstrated significantly higher Compassion Satisfaction and significantly lower Burnout as measured by the ProQOL, with professional support, social support, and age playing significant roles as well. CONCLUSIONS: Rituals may be an important way to increase compassion and decrease burnout among hospice staff and volunteers. Organizations may benefit from providing training and support for personalized rituals among team members, especially new staff who may be at greater risk for burnout.

Do the Kaufman tests of cognitive ability and academic achievement display construct bias across a representative sample of Black, Hispanic, and Caucasian school-age children in grades 1 through 12?

As the demographic profile in the United States continues to change and becomes ethnically more diverse, the need for culturally appropriate test instruments has become a national concern among educators, clinicians, and researchers. The Kaufman Assessment Battery for Children-2nd Edition (KABC-II) and the Kaufman Test of Educational Achievement-2nd Edition (KTEA-II) are 2 popular tests of intelligence and achievement, known to appeal to an ethnically diverse client population. The present study investigated test bias in terms of the test scores' construct validity across a nationally representative sample of Caucasian, Black, and Hispanic (N = 2,001) children in Grades 1-12. Confirmatory factor analysis was used to assess whether increasing sets of equality constraints fit the test scores' underlying theoretical model equally well for all 3 ethnic groups. Results showed that factorial invariance of the factor structure, based on 7 Cattell-Horn-Carroll (CHC) model broad abilities, was met for all 3 groups. Outcomes contribute to a scarce body of literature on ethnic test bias that goes beyond the simple comparison of mean score differences. Results of this study provide the evidence needed to justify continuous use of the KABC-II and KTEA-II in the assessment of minority group children and adolescents. Furthermore, findings are generalizable beyond the Kaufman tests to other popular tests of intelligence and achievement; this is because this study is based on the CHC factor structure, a universal theory of cognition that is used as the theoretical underpinning by many well-known tests of intelligence and achievement, including the most recent versions of the Wechsler scales. (PsycINFO Database Record

Gender Differences in Academic Achievement: Is Writing an Exception to the Gender Similarities Hypothesis?

The gender similarities hypothesis by J. S. Hyde ( 2005 ), based on large-scale reviews of studies, concludes that boys and girls are more alike than different on most psychological variables, including academic skills such as reading and math (J. S. Hyde, 2005 ). Writing is an academic skill that may be an exception. The authors investigated gender differences in academic achievement using a large, nationally stratified sample of children and adolescents ranging from ages 7-19 years (N = 2,027). Achievement data were from the conormed sample for the Kaufman intelligence and achievement tests. Multiple-indicator, multiple-cause, and multigroup mean and covariance structure models were used to test for mean differences. Girls had higher latent reading ability and higher scores on a test of math computation, but the effect sizes were consistent with the gender similarities hypothesis. Conversely, girls scored higher on spelling and written expression, with effect sizes inconsistent with the gender similarities hypothesis. The findings remained the same after controlling for cognitive ability. Girls outperform boys on tasks of writing.