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Sample size calculations based on day-to-day variability of stress biomarkers in persons with dementia and their family caregivers
Yale School of Nursing, Yale University, PO Box 27399, West Haven, CT, 06516 USA;Division of Occupational Therapy, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Fack 23 200, 141 83 Huddinge, Sweden.ORCID iD: 0000-0003-2608-9691
Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.ORCID iD: 0000-0003-1353-7125
Florida Atlantic University, Charles E. Schmidt College of Medicine, 777 Glades Road, Boca Raton, Florida, 33431 USA.ORCID iD: 0000-0002-2729-995x
Dalarna University, School of Health and Welfare, Medical Science. Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Box 564, 751 22 Uppsala, Sweden;Epistat AB, Kungsängsvägen 27, 753 23 Uppsala, Sweden.ORCID iD: 0000-0002-7437-9047
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2024 (English)In: BioSocial Health journal, E-ISSN 3060-6268, Vol. 1, no 3, p. 146-153Article in journal (Refereed) Published
Abstract [en]

Introduction: Accurate estimates of intra-individual variability are necessary for proper design of clinical trials and epidemiological studies where the stress biomarkers cortisol and dehydroepiandrosterone sulfate (DHEA-S) are measured for dyads of persons with dementia (PWDs) and their family caregivers (FCGs). The aim is to determine the number of consecutive sampling days required to detect effect differences in clinical trials, and to accurately estimate regression coefficients in epidemiological studies where stress biomarkers are exposure variables in regression models with future disease as outcome.Methods: Clinical trial data from dyads of PWDs and their FCGs were used. Salivary cortisol and DHEA-S samples were collected five days a week, for eight consecutive weeks. From this data, we created formulas and graphical tools for the number of required sampling days needed to detect effect differences, and we calculated number of days needed for regression coefficients to be estimated with < 10% bias.Results: A total of 5791 salivary samples from 34 dyads were used. For morning cortisol, five consecutive sampling days at baseline and an equal number of days at study termination is sufficient to detect a treatment difference > 5% of baseline level with > 20 dyads per group. When stress biomarkers are used in epidemiological studies at least six consecutive sampling days are required.Conclusion: Based on a large number of consecutive measurements of stress biomarkers we calculated the sufficient numbers of sampling days for clinical trials and for epidemiological studies to produce credible results. Our findings will aid researchers in the study design phase.

Place, publisher, year, edition, pages
Tabriz, Iran: Iranian Health Education & Promotion Association, Iranian Health Education & Promotion Association, Islamic Republic of Iran , 2024. Vol. 1, no 3, p. 146-153
Keywords [en]
Biomarkers, Caregivers, Clinical trial, Hydrocortisone, Dementia, Dehydroepiandrosterone sulfate, Epidemiologic studies, Sample size
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Public Health, Global Health and Social Medicine
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URN: urn:nbn:se:du-49776DOI: 10.34172/bshj.29OAI: oai:DiVA.org:du-49776DiVA, id: diva2:1918335
Available from: 2024-12-04 Created: 2024-12-04 Last updated: 2025-10-09Bibliographically approved

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Engström, GabriellaBerglund, Lars

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CiteExportLink to record
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