IntroductionEarly-life painful and stressful exposures have been associated with neurodevelopmental outcomes in preterm infants, however, findings regarding the roles of race, sex, and mother's own milk (MOM) intake in these associations are inconsistent.MethodA cohort of 196 infants (28 to 32 weeks' gestation) was followed from birth to 2 years corrected age (CA) and included in the study analyses. Painful and stressful exposures during the first 28 days of life were quantified using composite pain scores derived from the Neonatal Infant Stressor Scale. Neurodevelopment was assessed using the NICU Network Neurobehavioral Scale at 36–38 weeks postmenstrual age and the Bayley-III and BITSEA at 1- and 2- years CA. Linear mixed-effects and regression models were applied.ResultsHigher painful exposures during the first 28 days were associated with poorer self-regulation, attention, greater stress and lethargy (p < 0.05) at 36 to 38 weeks PMA. Among Black infants, higher composite pain scores predicted lower language, motor scores at 1- and 2- years CA and lower cognitive scores at 1 year CA (p < 0.05). Male infants with higher composite pain scores had lower motor scores at 1 year CA compared to female infants (p < 0.05). Greater MOM intake was linked to lower composite pain scores (p < 0.001) but did not moderate pain–neurodevelopment association.ConclusionBlack and male infants experienced higher painful exposures compared with White and female infants. Greater MOM intake showed a trend toward being protective, suggesting a potential role in individualized neonatal care.

Background Abdominal pain is the most distressing symptom of irritable bowel syndrome (IBS) and significantly impairs patients’ quality of life (QOL). The multifactorial nature of IBS-related pain poses challenges for effective management, and individual responses to self-management interventions vary widely. Aims This ancillary data analysis employed machine learning techniques to investigate contributors to IBS pain and outcomes of pain self-management over time. Methods and Design Data were drawn from a randomized controlled trial (NCT03332537) evaluating two remotely delivered self-management programs on pain, symptoms, and quality of life in 80 young adults with IBS. A machine learning approach, Bayesian Additive Regression Trees (BART), was used to identify predictors of pain outcomes over time. Predictor variables included baseline sociodemographic characteristics (gender, race, ethnicity, education, marital status, employment, age, and caregiver type), psychological measures (coping strategies, anxiety, depression, fatigue, and sleep), dietary intake measured by a food frequency questionnaire (FFQ), quantitative sensory testing (QST), gut microbiota composition (genus and species) from stool samples, and pain-related single nucleotide polymorphisms (SNPs), such as tumor necrosis factor superfamily TNFSF15 [rs4263839], catechol-O-methyltransferase (COMT) [rs6269], and SLC6A4 5-HTTLPR. Pain outcomes, measured by the brief pain inventory (BPI), were collected at baseline, 6 weeks and 12 weeks. Results Six BART models were developed to identify influential predictors of BPI severity and interference across the three timepoints. The top 20 influential predictors of BPI severity consistently included sociodemographic factors, psychological factors, dietary patterns, QST, SNPs, and specific genera and species of gut microbiota. Influential predictors of BPI interference varied across timepoints, but coping strategies (particularly catastrophizing), fatigue, QST, and gut microbiota composition were consistently among the top factors. Notably, baseline catastrophizing, a maladaptive coping strategy, emerged as the strongest predictor of both response to and maintenance of pain management, as reflected in BPI severity and interference scores at 6 and 12 weeks. Conclusions The study identified key predictors of IBS pain and pain management outcomes over time, emphasizing the impact of sociodemographic, psychosocial, genetic, and lifestyle factors on IBS pain. Implications for future research: The findings support a precision pain management approach in IBS by identifying distinct predictors of pain and treatment responses. The developed machine learning models offer the potential to tailor personalized interventions in clinical settings. Further studies with larger sample sizes are needed to verify these models.

To evaluate the associations between parental/family early relational contact in the neonatal intensive care unit (NICU) and the post-discharge childcare quality and behavioural development up to 18-24 months of corrected age (CA). In a longitudinal cohort study (2017-2022), 215 preterm infants were followed. Early relational NICU contact (minutes/day) was measured daily using a 12-item observational checklist. Post-discharge childcare quality was assessed at 18-24 months with the Index of Child Care Environment (ICCE). Behavioural development was assessed using the Bayley Scales of Infant Development III and the Brief Infant-Toddler Social and Emotional Assessment. Multiple regression models examined the associations between these key variables, adjusting for clinical and demographic confounders. The cohort was predominantly male (57.67%), non-Hispanic (74.88%) and White (67.44%), with an average gestational age of 28.3 weeks. At 18-24-month CA, greater early skin-to-skin/soothing contact was linked to better language development (beta = 0.33, p = 0.032), and integrated nurturing contact (characterised by holding combined with verbal interaction) was associated with better language and motor development in female infants (p's < 0.05); strong social support for caregivers was associated with infants' improved cognitive (beta = 0.364, p = 0.018), language (beta = 0.383, p = 0.008) and motor (beta = 0.382, p = 0.015) outcomes. Infants with typical social-emotional competence received higher levels of human stimulation from their caregivers compared with those showing possible competence issues (OR = 1.439, p = 0.020). Greater early NICU contact and higher post-discharge childcare quality are associated with improved developmental outcomes in preterm infants at 18-24 months CA, showing the growing importance of environmental factors in infants' development. Future studies should explore targeted interventions that enhance early bonding and empower parents to support sustained developmental progress.

Purpose This study evaluates the feasibility of auricular acupressure as a pain management strategy for cancer patients with neuropathic pain caused by tumor nerve compression, radiation, chemotherapy, or surgery. Design and Methods A 4-week pilot study included 14 cancer patients with neuropathic pain. Participants were trained to perform self-administration of auricular acupressure by daily stimulating specific ear acupoints tailored to their pain. Feasibility outcomes measured included withdrawal and adherence rates, pain symptoms, quality of life, and depression levels. Results The study had a 33.3% withdrawal rate, with 85.7% completing the intervention. Auricular acupressure significantly reduced pain severity, pain interference, and neuropathic pain while improving quality of life. However, there was no significant change in depression scores. Conclusions Auricular acupressure is a feasible nonpharmacological intervention for managing neuropathic pain in cancer patients, with high adherence and minimal side effects. Clinical Implications Auricular acupressure can serve as a valuable self-management tool for cancer patients, offering a noninvasive option for pain relief while empowering patients to actively participate in their care. Nurses and healthcare providers can incorporate auricular acupressure into patient education and chronic pain management programs, emphasizing its potential to reduce reliance on medications. Further research with larger, diverse samples and robust methodologies is recommended to confirm its long-term efficacy and optimize clinical protocols for broader implementation in oncology settings.

Background Cannabis use during the perinatal period continues to rise, yet its impacts on infant neurodevelopment remain unclear. With increasing cannabis potency, diverse ingestion methods, and unresolved confounding, refined study designs are needed to clarify these associations. Objective This scoping review aimed to synthesize evidence on perinatal cannabis exposure and infant neurodevelopment, focusing on reported outcomes, covariates and confounders, and how exposure was defined and measured. Methods We reviewed literature from January 2013 to September 2025 across five databases (CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science) guided by PRISMA-ScR guidelines. Studies were included if they examined the association between perinatal cannabis exposure and infant neurodevelopment. Data extraction was guided by a biopsychosocial model and addressed reproductive variables, and data synthesis was conducted using a narrative synthesis approach. Results A total of 2137 records were screened, with 12 studies included. Two studies found that prenatal cannabis exposure were associated with poorer self-regulation and visual processing outcomes. Ten studies found no direct associations, though one identified that cannabis exposed infants from low-income households had worse NICU Network Neurobehavioral Scale (NNNS) scores compared to high-income households. Key covariates included child sex, socioeconomic status, maternal comorbidities (e.g. hypertension), maternal anxiety and depression, and gestational age at birth. Few studies captured the multidimensionality of cannabis exposure, with only one quantifying tetrahydrocannabinol (THC) concentration and none assessing the route of use. Conclusion Key methodological gaps were identified in studies linking infant neurodevelopment and cannabis exposure. This scoping review offers guidance to enhance the robustness of findings in future empirical research.

Objective To identify sex-specific feeding patterns and associations with growth and neurodevelopment in preterm infants during NICU through 2 years of corrected age (CA). Methods A cohort study was conducted with 216 preterm infants (gestational age 28 0/7 to 32 0/7 weeks). Daily feeding regimens, including mother's own milk (MOM), human donor milk, and formula; daily growth; acute and chronic pain/stress were documented during NICU. NICU Network Neurobehavioral Scale (NNNS) (36 to 38 postmenstrual age), and Bayley Scales of Infant and Toddler Development (Bayley) Edition III (1 and 2 years of CA) were measured. Results Between week 9 to 16 after birth, only females showed a positive association between growth z-score and proportion of MOM intake before week 8 (p < 0.05). Sex-differentiated associations between MOM and stress were observed (p < 0.05). MOM proportion was positively correlated with language or cognitive scores at 2 years of CA in females (p = 0.01), this correlation not evident in males. Conclusions We discovered a sex-specific "window of opportunity" for feeding, growth and risk predictors for neurodevelopment up to 2 years of CA. These insights may inform development of tailored feeding regimens, potentially mitigating growth and development differences observed between males and females.

OBJECTIVES: To investigate the mediating effect of self-efficacy (SE) on the relationships among patient-provider partnership (PPP), pain, and quality of life (QOL) in individuals with cancer. SAMPLE & SETTING: Individuals with cancer were recruited online through cancer organizations and social media support groups in 2023. METHODS & VARIABLES: This cross-sectional survey collected data on demographic/clinical characteristics, cancer pain outcomes, PPP, SE for cancer pain management, and QOL. Mediation analyses assessed the role of SE in the relationships among PPP, pain, and QOL. RESULTS: Most participants were female, White, and aged 18-60 years. SE mediated the relationships between PPP and pain severity, pain interference, QOL function, and QOL symptoms. Greater PPP was associated with higher SE. IMPLICATIONS FOR NURSING: A supportive PPP is essential for improving pain outcomes and QOL in individuals with cancer by strengtheningtheir SE.

CONTEXT:Patients with colorectal cancer undergoing chemotherapy often experience significant pain and fatigue. Limitations in understanding the complex phenotypes and biological mechanisms of these symptoms hinder effective interventions. OBJECTIVES:This study aimed to identify the pain and fatigue patterns during one chemotherapy cycle and associated gene expression profiles. METHOD:In a prospective longitudinal study, 34 patients with colorectal cancer from a major cancer center in the Northeastern US were recruited. Self-reported outcome measures of pain and fatigue and blood samples were collected at baseline, post-chemotherapy, and at the end of the chemotherapy cycle. RNA sequencing followed by differential expression analysis identified changes in gene expression. Linear mixed models examined associations between symptoms and possible biomarkers over time. RESULTS:The sample had a mean age of 58.4 years old, with 97% being white and non-Hispanic. Among participants, 44.1% had stage III cancer, and 26.5% were undergoing initial chemotherapy. Abdominal pain was the most frequently reported symptom. Fatigue levels significantly worsened post-chemotherapy (P = 0.011) and after recovery (P = 0.018). Critical pathways involved inflammatory response and myeloid cell development (FDR < 5%). Mixed-effect linear regression analysis revealed statistically significant associations between the upregulation of LILRA6 and higher pain interference (β = -6.621, p = 0.010) and fatigue (β = -6.621, p = 0.010), as well as between the downregulation of CACNG6 (β = -1.043, p = 0.047) and PRSS33 upregulation (β = 1.384, p = 0.038) and increased pain interference. Given the small sample size, these findings should be interpreted with caution. CONCLUSION:These findings suggest inflammation and specific biomarkers may drive pain and fatigue during chemotherapy. Further preclinical models or clinical cohorts are needed to validate these results and explore potential implications for targeted interventions to reduce symptom burden in patients with colorectal cancer.

Wearable devices for continuous health monitoring in humans are constantly evolving, yet the signal quality may be improved by optimizing electrode placement. While the commonly used locations to measure electrodermal activity (EDA) are at the fingers or the wrist, alternative locations, such as the torso, need to be considered when applying an integrated multimodal approach of concurrently recording multiple bio-signals, such as the monitoring of visceral pain symptoms like those related to irritable bowel syndrome (IBS). This study aims to quantitatively determine the EDA signal quality at four torso locations (mid-chest, upper abdomen, lower back, and mid-back) in comparison to EDA signals recorded from the fingers. Concurrent EDA signals from five body locations were collected from twenty healthy participants as they completed a Stroop Task and a Cold Pressor task that elicited salient autonomic responses. Mean skin conductance (meanSCL), non-specific skin conductance responses (NS.SCRs), and sympathetic response (TVSymp) were derived from the torso EDA signals and compared with signals from the fingers. Notably, TVSymp recorded from the mid-chest location showed significant changes between baseline and Stroop phase, consistent with the TVSymp recorded from the fingers. A high correlation (0.77-0.83) was also identified between TVSymp recorded from the fingers and three torso locations: mid-chest, upper abdomen, and lower back locations. While the fingertips remain the optimal site for EDA measurement, the mid-chest exhibited the strongest potential as an alternative recording site, with the upper abdomen and lower back also demonstrating promising results. These findings suggest that torso-based EDA measurements have the potential to provide reliable measurement of sympathetic neural activities and may be incorporated into a wearable belt system for multimodal monitoring.

Background: Self-directed lifestyle modifications are essential for managing symptoms in individuals diagnosed with irritable bowel syndrome (IBS). This study incorporated longitudinal multi-omics profiling to estimate the mechanisms underlying responses to a nurse-led person-centered self-management intervention in young adults with IBS. Methods: This pre-post study was nested within a 12-week parent randomized controlled trial (NCT03332537). Biospecimens (stool and blood) and clinical outcomes were collected at baseline and post-intervention. Symptoms were assessed using the Brief Pain Inventory and PROMIS® short forms. Host transcriptomic profiling was performed using RNA sequencing, and gut microbial composition was analyzed via 16S rRNA sequencing. Host transcriptomic co-expression and microbial co-abundance modules were identified via weighted gene co-expression network analysis. Associations between multi-omics modules and symptoms were evaluated using linear mixed-effect models. Results: Among the 20 participants, most were non-Hispanic (75%), White (75%), and female (65%). The intervention significantly reduced self-reported pain severity (p = 0.019) and pain interference (p = 0.013). Decreased associations were observed between pain phenotypes and a microbial module enriched in core metabolic pathways (interference: β = -4.7, p < 0.001; severity: β = -2.4, p = 0.02). Anxiety strengthened associations with host transcriptomic cellular energy metabolism pathways post-intervention (p < 0.05). The intervention attenuated associations between fatigue, sleep disturbance, and immune-inflammatory transcriptomic and microbial adaptation modules (p < 0.05). Conclusions: Findings suggest that the IBS self-management intervention induces symptom-specific biological responses, implicating distinct host-microbe pathways. Larger longitudinal studies are warranted to validate these omics-based symptom signatures.

BACKGROUND:Along with the global rise in the population of older adults, addressing depression among this population has become a critical public health concern. Reminiscence therapy is one of the interventions shown to be effective in reducing depression and depressive symptoms. OBJECTIVES:To systematically summarize the effectiveness of reminiscence interventions in reducing depression and depressive symptoms in community-dwelling older adults without significant cognitive impairment. METHODS:The literature search was conducted through four electronic databases: PubMed, CINAHL, PsycINFO, and Scopus for studies published in English. Risks of bias were evaluated using the Cochrane Risk of Bias 2 tool and the Joanna Briggs Institute Quality Appraisal Instrument. RESULTS:The systematic review included 11 studies involving 650 community-dwelling older adults, with mean ages ranging from 65.3 to 78.7. Nine articles found reminiscence therapy effective in alleviating depression and depressive symptoms in community-dwelling older adults without significant cognitive impairment. Structured reminiscence interventions were effective in reducing depression and depressive symptoms in six out of seven studies. Group reminiscence interventions demonstrated significant improvements in depression in 87.5% of studies. Memories triggers, suggested by four included studies, were practical tools to help initiate reminiscence sessions. All included studies were rated as having a low risk of bias. CONCLUSION:Reminiscence has the potential as a valuable and effective treatment for depression and depressive symptoms in community-dwelling older adults without significant cognitive impairment. Future research should focus on exploring diverse modalities, incorporating active control groups, and having longer follow-up periods to assess sustained benefits.

BACKGROUND:Women from diverse socioeconomic status (SES) face a higher risk of preterm birth, increasing their infants' vulnerability to neurodevelopmental and other health disorders; however, the predictive role of maternal ZIP code level SES in these outcomes remains underexplored. OBJECTIVES:To investigate the associations between maternal racial disparity, ZIP code-level SES, and infant breastfeeding, growth, and neurodevelopmental trajectories. METHODS:In this cohort study, preterm infants were recruited from two Connecticut neonatal intensive care units (NICUs). Infant demographic data, feeding regimens, and growth during the NICU stay were documented. Neurodevelopmental outcomes were assessed using the NICU Neonatal Neurobehavioral Scale, the Bayley scale of infant and toddler development (3rd ed.), and the Brief Infant Toddler Social Emotional Assessment. To compare SES differences between infants born to Black and White mothers, both t -tests and Wilcoxon tests were conducted. We used XGBoost to analyze infant health outcomes and SHapley Additive exPlanations (SHAP) values to identify SES-related risk factors associated with feeding, growth during NICU stay, and neurodevelopmental outcomes up to 2 years of age. RESULTS:In total, 181 preterm infants from eight ZIP code areas were included in the study. The majority of infants were born to mothers who were White and non-Hispanic. Compared with infants born to White mothers, those born to Black mothers had younger birth gestational age (GA), lower birth weights, shorter birth lengths, smaller head circumferences, and higher Score of Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE-II), with all differences being statistically significant. Compared with White mothers, Black mothers were younger, single, and less educated. Black mothers also had lower median household incomes, larger average family sizes, and higher levels of poverty compared with White mothers. Based on SHAP values, the risk factors predicting infants' feeding, growth, and neurodevelopment are ranked as follows: birth weight, birth GA, SNAPPE-II score, average family size, maternal age, median household income, poverty level, and school enrollment. DISCUSSION:Maternal racial disparity and SES serve as predictors of feeding, growth, and neurodevelopmental outcomes in preterm infants. Understanding these associations can inform health care strategies for vulnerable preterm populations to improve long-term health outcomes.