{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T03:34:23Z","timestamp":1780457663476,"version":"3.54.1"},"reference-count":65,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"the Laurie Sunderman Excellence Fund in Multiple Sclerosis Research"},{"name":"the James Dougherty, Jr. Centennial Professorship in Nursing"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["West J Nurs Res"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Chronic stress may play a significant role in disease progression in individuals with multiple sclerosis (MS), but traditional methods of measuring stress through salivary and blood cortisol have limitations. Hair cortisol has emerged as a promising objective measure for chronic stress assessment, but its application in those with MS remains understudied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To explore the feasibility of hair sample collection for cortisol analysis among community-dwelling individuals with longstanding MS (disease duration \u226520\u2009years), including factors associated with participation and relationships between hair cortisol and self-reported measures, including perceived stress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this cross-sectional study, 75 participants completed surveys and provided usable hair samples for cortisol analysis. Factors associated with participation and correlations among study variables were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The completion rate for hair sample collection was 59.6% (n\u2009=\u200990). Of the samples returned, 83.3% (n\u2009=\u200975) were used in the analysis. Younger survey participants and those with shorter MS duration were more likely to provide usable hair samples. Hair cortisol showed no significant linear relationships with self-reported variables. In a multiple regression model to predict hair cortisol, employment was significantly associated with increased hair cortisol levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Hair sample collection for cortisol analysis is feasible in community-dwelling individuals with longstanding MS. The lack of correlation between hair cortisol and perceived stress reflects the complexity of measuring chronic stress in MS, as in other populations. Future research may consider multi-method approaches to collect hair samples and explore relationships between hair cortisol, perceived stress, and health promotion variables.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/01939459251405618","type":"journal-article","created":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T04:13:57Z","timestamp":1769314437000},"page":"357-370","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Hair Cortisol as a Biomarker of Chronic Stress in Community-Dwelling Adults With Longstanding Multiple Sclerosis"],"prefix":"10.1177","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3294-0519","authenticated-orcid":false,"given":"Nani","family":"Kim","sequence":"first","affiliation":[{"name":"School of Nursing, The University of Texas at Austin, Austin, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexa K.","family":"Stuifbergen","sequence":"additional","affiliation":[{"name":"School of Nursing, The University of Texas at Austin, Austin, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Becker","sequence":"additional","affiliation":[{"name":"School of Nursing, The University of Texas at Austin, Austin, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Swift-Scanlan","sequence":"additional","affiliation":[{"name":"School of Nursing, Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nico","family":"Osier","sequence":"additional","affiliation":[{"name":"School of Nursing, The University of Texas at Austin, Austin, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8794-8341","authenticated-orcid":false,"given":"Stephanie","family":"Buxhoeveden","sequence":"additional","affiliation":[{"name":"Accelerated Cure Project for Multiple Sclerosis, Waltham, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,24]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2020.05.049"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38041.724421.55"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2017.00316"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2024.06.004"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-023-03148-z"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.104142"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.12968\/bjnn.2013.9.4.172"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458514564487"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/cells12232726"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2023.23039"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-013-1140-7"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2005.03.011"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00184-3"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1590\/0004-282X20180091"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2011.09.009"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2012.02.002"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2016.12.017"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.25011\/cim.v30i5.2894"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00420-011-0727-3"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.3791\/57288"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/10998004221090468"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-019-02040-w"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/NNR.0000000000000672"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2020.104859"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-200005000-00002"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/NNR.0000000000000154"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2016.05.002"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.3791\/50882"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.psyneuen.2019.104376"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0379-0738(99)00146-2"},{"key":"e_1_3_3_33_2","unstructured":"Lobo ML. 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