A day in the life: Couples' everyday communication and subsequent relationship outcomes.

Understanding how communication processes contribute to well-functioning versus distressed couple relationships has relied largely on brief, laboratory-based conversations. Harnessing technological advancements, the present study extends the literature by capturing couples' naturalistic communication over one full day at Time 1 (T1). This study tested associations between data-driven categories of couple communication behaviors and relationship outcomes (i.e., relationship aggression, satisfaction, and dissolution) at Time 2 (T2), approximately 1 year later. Emerging adults in different-gender dating couples (n = 106 couples; 212 individuals; Mage = 22.57 ± 2.44; M relationship length = 30.49 months ± 24.05; 72.2% non-White) were each provided a smartphone programmed to audio record approximately 50% of a typical day. Interactions between partners were transcribed and coded for location, activity, affect, and a range of positive and negative communication behaviors for each partner. Even after controlling for T1 assessments of the relevant outcome, one's own hostility and one's partner's hostility at T1 were each positively associated with T2 relationship aggression and negatively associated with T2 relationship satisfaction. One's own withdrawal at T1 was positively associated with T2 relationship aggression perpetration, whereas one's partner's withdrawal was negatively linked to relationship satisfaction at T2. One's own playfulness, unexpectedly, was linked to lower subsequent relationship satisfaction. Withdrawal increased the likelihood of relationship dissolution, whereas warmth and playfulness decreased the likelihood of dissolution. The relevance of couples' ordinary, everyday communication for meaningful relationship outcomes is discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Anti-Black violence, discrimination, and sleep difficulties amongst racially diverse Americans: The aftermath of the murder of George Floyd.

RATIONALE: Following the murders of George Floyd and other Black Americans during the summer of 2020, there was unprecedented exposure to media-disseminated depictions of anti-Black violence. Little is known about the impact of this widespread form of vicarious racism that was pervasive during that historic time. OBJECTIVE: The present study applies the concept of vicarious racism to study this secondary exposure to anti-Black violence. We investigated negative impacts of anti-Black violence (NIAV) and personal experiences with discrimination in association with sleep difficulties, a critical intermediary health process. METHODS: Racially diverse Americans (N = 487) were recruited to participate in a cross-sectional study using an online survey given between December 11, 2020 and February 11, 2021. RESULTS: Black participants endorsed greater NIAV than Asian, Latinx, and White participants. Moreover, Black, Asian, and Latinx participants reported greater direct discrimination than White participants. NIAV and direct discrimination were each associated with more sleep difficulties. Although associations between NIAV and sleep difficulties did not vary by race, race moderated the association between direct discrimination and sleep difficulties. In addition, direct discrimination moderated the association between NIAV and sleep difficulties in an unanticipated direction: the link between NIAV and sleep difficulties was weaker for those experiencing more direct discrimination. CONCLUSION: Findings suggest that anti-Black violence and police brutality not only impact direct victims but have widespread vicarious impacts on racially diverse Americans, and highlight that vicarious anti-Black racism and discrimination are important issues of public health.

A Relationship-Based Resilience Program for Promotores: Protocol for a Randomized Controlled Waitlist Trial.

BACKGROUND: Community service providers (CSPs) play an integral role in the health care of low-income Hispanic or Latinx (HL) communities. CSPs have high-stress frontline jobs and share the high-risk demographics of their communities. Relational savoring (RS) has been associated with lower cardiovascular reactivity and psychosocial benefits, with particular promise among HL participants. In this study, we aim to identify RS's potential in promoting CSPs' cardiometabolic health and, in so doing, having broader impacts on the community they serve. OBJECTIVE: This randomized controlled waitlist study aims to examine the effect of an RS intervention on (1) CSPs' cardiometabolic health (cardiometabolic risk factors and outcomes) and (2) CSPs' threats to leaving the workforce. METHODS: We will recruit a sample of 80 CSPs from community health agencies serving low-income HL populations. Participating CSPs will be randomized into an experimental or a waitlist control. Participants will complete 1 or 2 baseline assessment batteries (before the intervention), depending on the assigned group, and then complete 2 more assessment batteries following the 4-week RS intervention (after the intervention and at a 3-mo follow-up). The RS intervention consists of guided reflections on positive moments of connection with others. Electrocardiogram data will be obtained from a wearable device (Polar Verity Sense or Movisens) to measure heart rate variability. The primary outcome is cardiometabolic health, consisting of cardiometabolic risk (obtained from heart rate variability) and cardiometabolic health behaviors. The secondary outcomes include CSPs' threats to leaving the workforce (assessed via psychological well-being), intervention acceptability, and CSPs' delivery of cardiometabolic health programming to the community (exploratory). Analyses of covariance will be used to examine the effects of RS on cardiometabolic health and on CSPs' threats to leaving the workforce, comparing outcomes at baseline, postintervention, and at follow-up across participants in the experimental versus waitlist group. RESULTS: The study has been approved by the University of California, Irvine, Institutional Review Board and is currently in the data collection phase. By May 2023, 37 HL CSPs have been recruited: 34 have completed the baseline assessment, 28 have completed the 4 intervention sessions, 27 have completed the posttreatment assessment, and 10 have completed all assessments (including the 3-mo follow-up). CONCLUSIONS: This study will provide valuable information on the potential of RS to support cardiometabolic health in HL CSPs and, indirectly, in the communities they serve. TRIAL REGISTRATION: ClinicalTrials.gov NCT05560893; https://clinicaltrials.gov/study/NCT05560893. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51427.

Multidimensional Discrimination Distress, Controlling Parenting, and Parent-Adolescent Attachment Relationships: Racial/Ethnic Differences.

Parents have multifaceted identities, across dimensions like race/ethnicity, gender, and class, which shape their experience of discrimination. However, little is known about how distress from such multidimensional discrimination influences parenting behavior and parent-adolescent relationships. We tested associations between mothers' multidimensional discrimination distress and parental control (overcontrol and conditional regard) and daughters' attachment, among 82 African American (AA), Hispanic/Latina (HL), and non-Hispanic White (NHW) mother-adolescent daughter dyads in the United States. Additionally, we examined whether these associations vary by race/ethnicity. Mothers reported their distress due to multidimensional discrimination and adolescents reported mothers' overcontrol, mothers' conditional regard, and adolescents' attachment to mothers. Across racial/ethnic groups, more multidimensional discrimination distress was associated with more maternal overcontrol. Additionally, racial/ethnic groups differed in associations between discrimination, maternal conditional regard, and adolescent attachment, such that AA mothers were buffered from the deleterious effects of discrimination on conditional regard and adolescent attachment. HL mothers were buffered from effects on adolescent attachment and conditional regard for anger expression, but not fear expression. Findings suggest that stigmatized racial/ethnic groups may rely on adaptive cultural practices to parent effectively in the face of multidimensional discrimination distress, but these resources may not be available to NHW mothers.

Savoring interventions for mothers of young children: Mechanisms linking relational savoring and personal savoring to reflective functioning.

Parenting interventions can improve parenting outcomes, with widespread implications for children's developmental trajectories. Relational savoring (RS) is a brief attachment-based intervention with high potential for dissemination. Here we examine data from a recent intervention trial in order to isolate the mechanisms by which savoring predicts reflective functioning (RF) at treatment follow-up through an examination of the content of savoring sessions (specificity, positivity, connectedness, safe haven/secure base, self-focus, child-focus). Mothers (N = 147, Mage  = 30.84 years, SDage  = 5.13; Race: 67.3% White/Caucasian, 12.9% other or declined to state; 10.9% biracial/multiracial, 5.4% Asian, 1.4% Native American/Alaska Native, 2.0% Black/African American; Ethnicity: 41.5% Latina) of toddlers (Mage  = 20.96 months, SDage  = 2.50; 53.5% female) were randomized to four sessions of RS or personal savoring (PS). Both RS and PS predicted higher RF, but through different means. RS was indirectly associated with higher RF through greater connectedness and specificity of savoring content, while PS was indirectly associated with higher RF through greater self-focus in savoring content. We discuss the implications of these findings for treatment development and for our understanding of the emotional experience of mothers of toddlers.

Las intervenciones sobre la crianza pueden mejorar los resultados, con implicaciones ampliamente extendidas para las trayectorias de desarrollo de los niños. Disfrute de la Relación (RS) es una intervención breve con base en la afectividad que tiene un alto potencial para ser diseminada. Aquí examinamos los datos de un reciente ensayo de intervención con el fin de aislar los mecanismos por medio de los cuales el disfrutar predice el funcionamiento con reflexión (RF) al momento del seguimiento del tratamiento a través de una examinación del contexto de las sesiones de disfrutar (especificidad, positividad, sentido de conexión, refugio seguro/base segura, auto enfoque, enfoque en el niño). Las madres (N = 147, edad promedio = 30.84 años, desviación estándar por edad = 5.13; Raza: 67.3% blanca/cáucasa, 12.9% otra o se negó a indicarla; 10.9% birracial/multirracial, 5.4% asiática, 1.4% indígena americana/indígena de Alaska, 2.0% negra/afroamericana; Etnicidad: 41.5% latina) de niños pequeñitos (edad promedio = 20.96 meses, desviación estándar por edad = 2.50; 53.5% niñas) fueron asignadas al azar a 4 sesiones de RS o de disfrute personal (PS). Ambas, RS y PS predijeron una más alta RF, pero por diferentes medios. Se asoció RS indirectamente con una más alta RF a través de un mayor sentido de conexión y especificidad del contenido de disfrute, mientras que PS se asoció indirectamente con una mayor RF a través de un mayor auto enfoque en el contenido de disfrute. Discutimos las implicaciones de estas observaciones para el desarrollo del tratamiento y para nuestra comprensión de la experiencia emocional de madres y niños pequeñitos.

Les interventions de parentage peuvent améliorer les résultats de parentage, avec des implications généralisées pour les trajectoires de développement des enfants. La Saveur relationnelle (relational savoring en anglais, soit RS) est une intervention basée sur l'attachement brève, ayant un fort potentiel de dissémination. Nous examinons ici des données de l'essai d'intervention récent de façon à isoler les mécanismes par lesquels le fait de savourer prédit le fonctionnement de réflexion (RF) au suivi du traitement au travers d'un examen du contenu des session de saveur (spécificité, positivité, connexion, refuge/base sûre, concentration, concentration-enfant). Les mères (N = 147, Mâge = 30,84 ans, SDâge = 5,13; Race: 67,3% blanches, 12,9% autre race ou ont préféré ne pas répondre; 10,9% métis/multiraciales, 5,4% asiatiques, 1,4% autochtones/natives de l'Alaska, 2,0% noires/Africaines Américaines; Ethnicité: 41.5% latinas) de jeunes enfants (Mâge = 20,96 mois, SDâge = 2,50; 53,5% de sexe féminin) ont été randomisées en 4 séances de RS ou de Saveur Personnelle (SP). La RS et la SP ont prédit un RF plus élevé mais à travers différents moyens. La RS était indirectement liée à un RF plus élevé au travers d'une plus grande connexion et une spécificité du contenu de saveur, alors que la SP était indirectement liée à une RF plus élevé au travers d'une plus grande concentration en savourant le contenu. Nous discutons les implications de ces résultats pour le développement d'un traitement et pour notre compréhension de l'expérience émotionnelle des mères de jeunes enfants.

Parents' depressive symptoms and reflective functioning predict parents' proficiency in relational savoring and children's physiological regulation.

This study examined parental depression and parental reflective functioning (PRF) as predictors of parental proficiency in relational savoring (RS), the association between RS proficiency and a marker of children's physiological self-regulation, respiratory sinus arrhythmia (RSA), during a stressor, and indirect effects of parental depression and PRF on children's RSA via parents' RS. At Time 1 (T1), parents of 8- to 12-year-old children (N = 139) reported on their depressive symptoms and completed a parenting interview, coded for PRF. After 1.5 years (Time 2; T2), parents savored a positive relational memory that involved their children, which was coded for savoring proficiency. Children's RSA was measured during a stressful task (a series of impossible puzzles). Depressive symptoms (inversely) and PRF (positively) were associated with RS proficiency. Higher parental RS proficiency was associated with children's higher mean levels of RSA during the stressor. Indirect effects models supported that T2 RS proficiency mediated the negative association between parental T1 depressive symptoms and children's T2 RSA, and between T1 PRF and children's T2 RSA. We discuss these findings in terms of implications for parents' emotion regulation, children's emotion regulation, children's mental health, and intervention.

What happens when romantic couples discuss personal loss? Relational, emotional, and physiological impacts.

Does talking about loss with a romantic partner have salutary personal and relationship effects? Prior evidence reveals the benefits of emotional disclosure in couple relationships, yet disclosure about loss has been overlooked in research on couple communication. Using a novel communication paradigm with young-adult heterosexual romantic partners (N = 114 couples), we investigated emotions, physiological arousal (skin conductance responses [SCR]), and relationship closeness when narrating a personal loss and listening to the partner's loss, and compared these loss discussions to discussions about desired relationship changes. Based on partners' self-reports, narrating loss elicited more vulnerable and, unexpectedly, more antagonistic emotions. Both narrating and listening to loss produced higher self-reported partner closeness, compared to discussing change. In support of the physiological benefits of disclosure, women's SCRs decreased over the discussion when they narrated their own loss. However, both women and men as listeners show a general trend of increasing SCRs over the discussion, suggesting the challenges of being a responsive partner. Moreover, in line with the putative protective effects of partners' biological interdependencies, partner closeness also was higher when both partners showed synchronous decreasing SCR as women narrated their loss. Although limited to young couples in relatively short relationships, these findings reveal some potential benefits of talking about loss in the context of romantic relationships. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Negative affect, childhood adversity, and adolescents' eating following stress.

Obesity commonly emerges by adolescence and is associated with serious health consequences. Emotional eating (consuming calories, fats, and sugars in response to negative affect) may promote obesity; however, evidence is mixed as to whether negative affect increases obesogenic eating. Early-life adversity may shape malleable neurobiological systems that govern inhibitory control, physiological regulation, coping strategies, and eating behavior, contributing to greater obesogenic eating in response to negative affect. Therefore, this study tested whether childhood adversity moderates the association between negative affect and food consumption in a diverse sample of female adolescents. After completing a childhood adversity assessment, 157 female adolescents (13-17 years; 28.7% African American, 39.5% Hispanic/Latina, 31.8% Non-Hispanic White) rated their negative affect in response to a standard social stress paradigm before consuming a buffet lunch, which was evaluated for calories, added sugars, and solid fats consumed. Results did not support that negative affect exerted a main effect on eating behavior. However, negative affect and childhood adversity interacted to predict calories and solid fats consumed, such that negative affect was associated with more obesogenic eating for those with high adversity exposure but not for those with low adversity exposure. Adversity and affect did not interact to predict added sugars consumed. Findings support that eating patterns in response to negative affect may differ by childhood adversity history. Reducing children's adversity exposure and bolstering emotion regulation techniques for adolescents who have been exposed to adversity may provide pathways to protect health and well-being by reducing maladaptive eating patterns.

Racial/ethnic differences in dietary intake among a diverse sample of adolescents: An experimental study.

BACKGROUND: African-American (AA) and Hispanic/Latina (HL) females have higher obesity prevalence than do non-Hispanic Whites (NHW); this may be due to AA and HL consuming more energy-dense foods in response to stressors. OBJECTIVES: This study examined racial/ethnic differences in dietary intake under controlled conditions (relaxation and stress) in a diverse sample of adolescent females. METHODS: Participants included 120 adolescent females (30% AA, 37% HL and 33% NHW) who participated in a laboratory food intake study. Using a randomized cross-over design, ad libitum food consumption was measured following control/relaxation and social-evaluative stress conditions. Food intake was indexed as consumed calories, added sugars and solid fats. RESULTS: The effect of laboratory conditions on food intake varied by race/ethnicity, such that AA consumed more energy following relaxation than following stress. For NHW and HL, food intake did not differ between conditions. CONCLUSIONS: To the best of our knowledge, these findings are the first to directly observe racial/ethnic differences in food intake in response to acute stress, which may contribute to obesity-related health disparities.

Stress-Induced Eating Among Racial/Ethnic Groups in the United States: a Systematic Review.

OBJECTIVE: Racial/ethnic disparities in obesity may be due, in part, to minority groups consuming more energy-rich diets in response to greater stress exposure. The present study systematically reviewed the literature describing the effects of stress on food consumption among various racial/ethnic groups in the US. METHODS: PubMed and PsycINFO databases were searched for studies reporting associations between stress and food consumption by different racial/ethnic groups, conducted between January 1, 1999 to November 25, 2019. The search included terms related to food consumption, stress, and race/ethnicity. After screening 3660 records, 30 studies were included for review. RESULTS: The selected studies assessed diverse stressors and eating constructs; African-American and Hispanic/Latinx were the most commonly studied minority groups. Studies generally supported that diverse forms of stress exposure are associated with reduced healthy eating patterns and increased obesogenic eating patterns across racial/ethnic groups. However, studies that directly compared stress-eating associations among multiple racial/ethnic groups showed mixed results. CONCLUSION: Members of diverse racial/ethnic groups are susceptible to stress-induced unhealthy eating patterns, though evidence is insufficient to conclude whether the degree of susceptibility differs among groups. Additional studies utilizing observational measures of food intake and culturally sensitive measures of stress are needed to identify the most influential stressors on dietary behaviors, to assess whether some stressors are more salient for given racial/ethnic groups, and to examine the extent to which stress-induced eating contributes to racial/ethnic disparities in obesity and obesity-related diseases.

Family aggression and attachment avoidance influence neuroendocrine reactivity in young adult couples.

Family-of-origin aggression (FOA) exposure is a chronic childhood stressor that has been linked to altered stress reactivity of the hypothalamic-pituitary-adrenal (HPA) axis in adulthood. The effects of FOA also spill over between partners in romantic couples, such that one partner's FOA history influences the other's HPA reactivity during couple interactions. However, the direction of these effects is inconsistent, with both heightened and blunted HPA reactivity observed; this heterogeneity suggests the presence of moderators. This study measured HPA reactivity during emotionally vulnerable conversations between young adult romantic partners to assess whether romantic attachment avoidance accounts for this divergence by moderating actor and partner effects of FOA on HPA. A total of 112 opposite-sex couples (224 young adults) provided information on FOA and avoidance, completed dyadic interaction procedures, and provided saliva samples to assess HPA reactivity during interactions. Multilevel structural equation models revealed that FOA did not predict either the actor's or the partner's HPA reactivity. However, FOA and avoidance interacted to produce both actor and partner effects, such that greater FOA exposure heightened HPA reactivity when avoidance was high but blunted reactivity when avoidance was low. The results support the conjecture that proximal relationship-related characteristics, such as attachment avoidance, influence whether distal relationship-related stressors, such as FOA, amplify or attenuate physiological reactivity during emotionally vulnerable interactions. Because HPA reactivity has been linked to a variety of health outcomes, identifying relationship-related buffers of associations between FOA and HPA response may inform future interventions to protect health for FOA-exposed youth. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Adverse childhood experiences, daily worries, and positive thoughts: A daily diary multi-wave study.

OBJECTIVE: To examine adverse childhood experiences (ACEs) as a prospective predictor of the day-to-day associations between worries and positive thinking among late adolescents. METHOD: Cumulative ACEs were measured from parent and youth reports between the ages of 9.9 and 18.1. Late adolescents (N = 103) reported daily worries and positive thoughts across ten days. RESULTS: Adverse childhood experiences predicted higher and more variable levels of day-to-day worry. Increases in positive thinking on one day predicted less next-day worry for adolescents with low, but not high, ACE scores. CONCLUSIONS: Daily worry during late adolescence may be an important consequence of earlier exposure to ACEs. Early interventions focused on worry reduction and improved emotion regulation might mitigate worry among high-ACE youth.

A study of prospective surveillance for inhibitors among persons with haemophilia in the United States.

Inhibitors are a rare but serious complication of treatment of patients with haemophilia. Phase III clinical trials enrol too few patients to adequately assess new product inhibitor risk. This project explores the feasibility of using a public health surveillance system to conduct national surveillance for inhibitors. Staff at 17 U.S. haemophilia treatment centres (HTC) enrolled patients with haemophilia A and B into this prospective study. HTC staff provided detailed historic data on product use and inhibitors at baseline, and postenrolment patients provided monthly detailed infusion logs. A central laboratory performed inhibitor tests on blood specimens that were collected at baseline, annually, prior to any planned product switch or when clinically indicated. The central laboratory also performed genotyping of all enrolled patients. From January 2006 through June 2012, 1163 patients were enrolled and followed up for 3329 person-years. A total of 3048 inhibitor tests were performed and 23 new factor VIII inhibitors were identified, 61% of which were not clinically apparent. Infusion logs were submitted for 113,205 exposure days. Genotyping revealed 431 distinct mutations causing haemophilia, 151 of which had not previously been reported elsewhere in the world. This study provided critical information about the practical issues that must be addressed to successfully implement national inhibitor surveillance. Centralized testing with routine monitoring and confirmation of locally identified inhibitors will provide valid and representative data with which to evaluate inhibitor incidence and prevalence, monitor trends in occurrence rates and identify potential inhibitor outbreaks associated with products.

Comparison of clot-based, chromogenic and fluorescence assays for measurement of factor VIII inhibitors in the US Hemophilia Inhibitor Research Study.

BACKGROUND: Detection and validation of inhibitors (antibodies) to hemophilia treatment products are important for clinical care, evaluation of product safety and assessment of population trends. METHODS: Centralized monitoring for factor VIII (FVIII) inhibitors was conducted for patients in the Hemophilia Inhibitor Research Study using a previously reported modified Nijmegen-Bethesda clotting assay (NBA), a chromogenic Bethesda assay (CBA) and a novel fluorescence immunoassay (FLI). RESULTS: NBA and CBA were performed on 1005 specimens and FLI on 272 specimens. CBA was negative on 880/883 specimens (99.7%) with Nijmegen-Bethesda units (NBU) < 0.5 and positive on 42/42 specimens (100%) with NBU ≥ 2.0 and 43/80 specimens (53.8%) with NBU 0.5-1.9. Among specimens with positive NBA and negative CBA, 58.1% were FLI negative, 12.9% had evidence of lupus anticoagulant, and 35.5% had non-time-dependent inhibition. CBA and FLI were positive on 72.4% and 100% of 1.0-1.9 NBU specimens and 43.1% and 50.0% of 0.5-0.9 NBU specimens. FLI detected antibodies in 98.0% of CBA-positive and 81.6% of NBA-positive specimens (P = 0.004). Among 21 new inhibitors detected by NBA, five (23.8%) with 0.7-1.3 NBU did not react in CBA or FLI. Among previously positive patients with 0.5-1.9 NBU, 7/25 (28%) were not CBA or FLI positive. FLI was positive on 36/169 NBU-negative specimens (21.3%). CONCLUSIONS: FVIII specificity could not be demonstrated by CBA or FLI for 26% of inhibitors of 0.5-1.9 NBU; such results must be interpreted with caution. Low titer inhibitors detected in clot-based assays should always be repeated, with consideration given to evaluating their reactivity with FVIII using more specific assays.

F8 and F9 mutations in US haemophilia patients: correlation with history of inhibitor and race/ethnicity.

Both genetic and treatment-related risk factors contribute to the development of inhibitors in haemophilia. An inhibitor surveillance system piloted at 12 US sites has the goal of assessing risk factors through prospective data collection. This report examines the relationship of genotype and race/ethnicity to history of inhibitor in a large cohort of US haemophilia patients. Mutation analysis was performed on 676 haemophilia A (HA) and 153 haemophilia B (HB) patients by sequencing, Multiplex Ligation-dependent Probe Amplification, and PCR for inversions in F8 introns 22 (inv22) and 1 (inv1). Two HB patients with deletions had history of inhibitor. In severe HA, frequency of history of inhibitor was: large deletion 57.1%, splice site 35.7%, inv22 26.8%, nonsense 24.5%, frameshift 12.9%, inv1 11.1% and missense 9.5%. In HA, 19.6% of 321 White non-Hispanics (Whites), 37.1% of 35 Black non-Hispanics (Blacks) and 46.9% of 32 Hispanics had history of inhibitor (P = 0.0003). Mutation types and novel mutation rates were similar across ethnicities. When F8 haplotypes were constructed, Whites and Hispanics showed only H1 and H2. Within H1, history of inhibitor was 12.4% in Whites, 40.0% in Blacks (P = 0.009) and 32.4% in Hispanics (P = 0.002). Inhibitor frequency is confirmed to vary by mutation type and race in a large US population. White patients with history of inhibitor did not exhibit rare F8 haplotypes. F8 gene analysis did not reveal a cause for the higher inhibitor frequencies in Black and Hispanic patients.

Comparison of normal or heparinised saline flushing on function of arterial lines.

BACKGROUND: Heparin is used as a flush solution for intravenous and intra-arterial lines, but has a number of drug interactions, as well as potentially serious side effects. METHODS: We compared the function of arterial lines for both monitoring and blood sampling when flushed with either normal saline or saline containing heparin (1 unit/mL). Sixty-five patients were recruited at this mixed medical and surgical Level 2 intensive care unit. Patients were randomised to receive either normal saline (NS) or heparinised saline (HS) (3 mL/hour as a continuous flush). Each patient's nurse was asked to score the function of the line at the end of each nursing shift. RESULTS: 35 patients were recruited in the NS group and 30 in the HS group. Mean study duration was 5.8 and 6.6 days for the NS and HS groups, respectively. The scores for the intravascular line for each patient were summed, and the percentage of the total possible score was calculated. Mean percentage scores were 83% (NS group) and 82% (HS group). Comparison using the central limit theorem showed no difference between the groups at the 95% confidence interval (-6% to 10%). CONCLUSIONS: Heparin as a continuous flush at 3 units/hour does not improve the function of arterial lines compared with a continuous normal-saline flush.

Effect of heparin in arterial line flushing solutions on platelet count: a randomised double-blind study.

INTRODUCTION: Arterial catheters are widely used in intensive care units for continuous blood pressure monitoring and blood sampling. Studies have examined the effect of heparin on patency of arterial catheters but not on platelet counts. Heparin is a naturally occurring anticoagulant that helps prevent clotting and is given to prevent and treat thrombosis. It has many other effects, including reducing platelet counts. METHODS: A prospective, randomised, double-blind study compared the effects of heparinised and normal saline (both administered via a continuous flush device to an arterial catheter) on patients' platelet counts. All patients admitted to a mixed medical-surgical ICU between April and December 2003 were eligible for entry. Exclusion criteria were age under 16 years, known sensitivity to heparin, pre-existing coagulopathy that precluded heparin, or requirement for therapeutic heparin. Lines were inserted into radial, brachial or femoral arteries. A 500 mL bag of saline for the flush was injected with numbered syringes, containing either normal saline (NS, 35 patients) or 500 IU heparin (HS, 30 patients), and pressurised. Platelet count was assessed daily. RESULTS: Mean platelet counts were 234.6 x 10(9)/L (NS) versus 256.6 x 10(9)/L (HS). Comparison using the central limit theorem showed means were not different at the 95% confidence interval (- 77.6 to 37 x 10(9)/L). CONCLUSION: Use of heparin in normal saline as a continuous flush for an arterial catheter does not reduce platelet counts in critically ill patients.