Leadership Coaching for Team Support: Prioritize Self-Care First!

Self-care quickly became a buzzword for health care workers during the recent pandemic. Strategies to improve self-care and build resiliency for our first-line workers were often seen in the literature or as topics at conferences and webinars. One strategy that was missing was the importance of leaders to be self-care role models for our employees. Just as leaders need to role model the organization's values, they also need to role model self-care so employees can follow their example and be assured that their leader views self-care as important. Leadership coaching must now include self-care as a strategy to improve not only the leader's mental, physical, and emotional health but also the health and wellness of their team as well as the entire organization.

Associations Between Child Sleep Problems and Maternal Mental Health in Children with ADHD.

Objective/Background: Children with attention-deficit/hyperactivity disorder (ADHD) experience more sleep problems than typically developing children. In addition, higher rates of depression are experienced by mothers of children with ADHD compared to mothers of children without ADHD. This study aimed to determine whether particular sleep problems in children with ADHD are associated with specific maternal mental health difficulties. Participants: Female caregivers of 379 children with ADHD (5-13 years) participated. The child's ADHD diagnosis was reconfirmed during recruitment by caregivers completing the ADHD Rating Scale-IV. Method: Caregivers reported on their mental health using the Depression Anxiety Stress Scale and their child's sleep using the Children's Sleep Habits Questionnaire. Unadjusted and adjusted regression analyzes were undertaken. Results: In the adjusted analyzes, there were small significant associations between most aspects of child sleep (i.e. Bedtime Resistance, Night Waking, Parasomnias, Sleep Duration, Daytime Sleepiness and Total Sleep Problems) and maternal Anxiety and Stress, with the exception of Sleep-Onset Delay. Bedtime Resistance, Sleep Duration, Daytime Sleepiness and Total Sleep Problems also had small significant associations with maternal Depression. Sleep Anxiety had a small significant association with maternal Anxiety only. Conclusions: This study demonstrates important connections between many child sleep problems and particular aspects of maternal mental health, suggesting adaptations to behavioral sleep interventions for children and mental health interventions for parents to take a family approach may be beneficial. Future research should consider the longitudinal associations between child sleep and parent mental health in an effort to inform future intervention approaches.

Racism, racial discrimination, and trauma: a systematic review of the social science literature.

Objective: The aim of this paper is to provide a systematic review of studies that examine relationships between racial discrimination and trauma in order to further understand the relationship between racial oppression and psychological functioning.Design: In this review, we describe the characteristics of 28 studies, identified by a comprehensive search strategy, including measurements of racial discrimination and trauma, as well as the nature of the reported associations.Results: Half of studies included in this review were published in the last 6 years. The majority of studies used cross-sectional designs and were conducted in the United States with adults ≥18 years old. African American, White, Latinx, and Asian populations were most frequently included in these studies. Of the 44 associations examined in these studies, 70% of the trauma symptomology outcomes were statistically significantly associated with racial discrimination. Significant positive associations ranged in strength, with the strongest relationships between racial discrimination and trauma occurring in studies examining veteran populations and moderate relationships among these variables in non-veteran, student populations.Conclusions: Our findings reveal that current research on race-based trauma seems to be limited by a lack of measures that capture the stress/intensity associated with race-related events, an inability to account for vicarious/collective/intergenerational experiences of trauma, and failure to control for non-race-based trauma.

Lessons Learned Conducting Dialectical Behavior Therapy via Telehealth in the Age of COVID-19.

Given the severity and suicide risk of patients typically treated by Dialectical Behavior Therapy (DBT) and the absence of guidelines regarding delivery of DBT via telehealth, it is crucial that the DBT treatment community gather and rapidly disseminate information about effective strategies for delivering DBT via telehealth. The current study surveyed DBT providers (N = 200) to understand challenges and lessons learned as they transitioned to conducting DBT via telehealth during the COVID-19 pandemic. Open-ended responses to challenges and lessons-learned were coded. Most frequently noted challenges were Therapy-Interfering Behaviors and elements related to the provision of Individual Therapy and Skills Training Group. The majority of providers offered advice for implementing group skills training, avoiding or overcoming therapist burnout, and emphasized continued adherence to treatment principles, even in the context of this new treatment modality. Overall, this qualitative study marks a starting point on identifying best practices delivering DBT via telehealth for which it is anticipated that clinical recommendations in this area will evolve, informed by clinician, researcher, and consumer input.

Overwhelmed by Emotion: Pathways from Revictimization to Mothers' Negative Emotional Responsivity.

Maternal history of childhood abuse has consistently been linked to increased risk for poor emotional adjustment and parenting as an adult. The aim of this study was to examine a model that may explain the link between maternal history of childhood abuse and mothers' tendencies to respond negatively to their adolescent children's negative emotions. A community sample of 66 mothers with adolescent children participated. Path analysis supported associations between mothers with a history of high betrayal trauma revictimization (i.e., trauma perpetrated by someone close to the mother during childhood and again as a young adult) and increased difficulty regulating their emotions. In turn, mothers who struggled to regulate their own emotions were also more likely to respond negatively to their adolescent's negative emotions. Findings highlight effects of childhood trauma may be particularly problematic for mothers who are revictimized as young adults. These results provide the foundation for future research evaluating clinical interventions targeted at increasing maternal emotion regulation skills.

Effects of soil type and light on height growth, biomass partitioning, and nitrogen dynamics on 22 species of tropical dry forest tree seedlings: Comparisons between legumes and nonlegumes.

PREMISE OF THE STUDY: The seedling stage is particularly vulnerable to resource limitation, with potential consequences for community composition. We investigated how light and soil variation affected early growth, biomass partitioning, morphology, and physiology of 22 tree species common in tropical dry forest, including eight legumes. Our hypothesis was that legume seedlings are better at taking advantage of increased resource availability, which contributes to their successful regeneration in tropical dry forests. METHODS: We grew seedlings in a full-factorial design under two light levels in two soil types that differed in nutrient concentrations and soil moisture. We measured height biweekly and, at final harvest, biomass partitioning, internode segments, leaf carbon, nitrogen, δ13C, and δ15N. KEY RESULTS: Legumes initially grew taller and maintained that height advantage over time under all experimental conditions. Legumes also had the highest final total biomass and water-use efficiency in the high-light and high-resource soil. For nitrogen-fixing legumes, the amount of nitrogen derived from fixation was highest in the richer soil. Although seed mass tended to be larger in legumes, seed size alone did not account for all the differences between legumes and nonlegumes. Both belowground and aboveground resources were limiting to early seedling growth and function. CONCLUSIONS: Legumes may have a different regeneration niche, in that they germinate rapidly and grow taller than other species immediately after germination, maximizing their performance when light and belowground resources are readily available, and potentially permitting them to take advantage of high light, nutrient, and water availability at the beginning of the wet season.

Evidence of distinct populations of hepatitis C virus in the liver and plasma of patients co-infected with HIV and HCV.

Viral diversity is an important predictor of hepatitis C virus (HCV) treatment response and may influence viral pathogenesis. HIV influences HCV variability in the plasma; however, limited data on viral variability are available from distinct tissue/cell compartments in patients co-infected with HIV and HCV. Thus, this exploratory study evaluated diversity of the hypervariable region 1 (HVR1) of HCV in the plasma and liver for 14 patients co-infected with HIV and HCV. Median intra-patient genetic distances and entropy values were similar in the plasma and liver compartments. Positive immune selection pressure was observed in the plasma for five individuals and in the liver for three individuals. Statistical evidence supporting viral compartmentalization was found in five individuals. Linear regression identified ALT (P = 0.0104) and AST (P = 0.0130) as predictors of viral compartmentalization. A total of 12 signature amino acids that distinguish liver from plasma E1/HVR1 were identified. One signature amino acid was shared by at least two individuals. These findings suggest that HCV compartmentalization is relatively common among patients co-infected with HIV and HCV. These data also imply that evaluating viral diversity, including drug resistance patterns, in the serum/plasma only may not adequately represent viruses replicating with in the liver and, thus, deserves careful consideration in future studies.

Reappraisal inventiveness: the ability to create different reappraisals of critical situations.

In this article, we propose a new ability approach to reappraisal that focuses on individual differences in the ability to spontaneously generate different reappraisals for critical situations. Adopting concepts from the realms of creativity and divergent thinking, we developed the Reappraisal Inventiveness Test (RIT) to measure a person's fluency and flexibility in inventing as many categorically different reappraisals for an anger-eliciting situation as possible within a limited period of time. The results of two studies in which we examined the psychometric characteristics of the RIT provided evidence that the RIT produces reliable test scores. The construct validity of the RIT was confirmed by positive associations of reappraisal inventiveness with openness to experience and tests that measure divergent thinking. Moreover, RIT performance proved to be unrelated to the self-reported habitual use of reappraisal, indicating differences between ability tests and self-report measures. RIT performance was not significantly related to Neuroticism or to trait anger. In our view, this points to the notion that effective emotion regulation is a function of both the ability and the motivation to act upon one's ability to generate reappraisals for critical situations.

Systemic trauma.

Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

A report on neurogenic bladder in COVID-19 vaccine-associated acute transverse myelitis.

INTRODUCTION: Acute transverse myelitis (ATM) is a rare neurological complication of Coronavirus disease (COVID-19) vaccines. Various vaccines have been linked to ATM, such as non-replicating viral vectors, ribonucleic acid, and inactivated vaccines. An ATM case is presented here involving the BNT162b2 vaccine leading to asymmetrical incomplete paraplegia and neurogenic bladder. CASE PRESENTATION: A 66-year-old male developed urinary retention one day after his second dose of the BNT162b2 vaccine, followed by rapidly progressing lower limb weakness. Clinical examination showed asymmetrical paraparesis, reduced sensation below the T8 level, including perianal sensation, and loss of ankle and anal reflexes. Laboratory tests were largely unremarkable, while the spine MRI revealed thickened conus medullaris with a mild increase in T2/STIR signal intensity and subtle enhancement post gadolinium. Following treatment with methylprednisolone, plasmapheresis, and immunoglobulin, and a rehabilitation program, the patient achieved good motor and sensory recovery, but the bladder dysfunction persisted. Single-channel cystometry indicated neurogenic detrusor underactivity and reduced bladder sensation, as evidenced by low-pressure and compliant bladder. The urethral sphincter appeared intact or overactive. The post-void residual urine was significant, necessitating prolonged intermittent catheterisation. DISCUSSION: Bladder dysfunction due to the COVID-19 vaccine-associated ATM is not as commonly reported as motor or sensory deficits. To our knowledge, this is the first case to highlight a neurogenic bladder that necessitates prolonged intermittent catheterisation as a consequence of COVID-19 vaccine-associated ATM. This report highlights the rare complication of the neurogenic bladder resulting from the BNT162b2 vaccine. Early detection and treatment are crucial to prevent long-term complications.

Limited infection with occult hepatitis B virus in drug users in the USA.

AIM: Occult HBV infection (O-HBV) is defined as low level HBV replication in the absence of detectable circulating HBV surface antigen. O-HBV has been implicated in HBV reactivation, advanced liver fibrosis and cirrhosis, reduced interferon response rates, elevated liver enzyme levels, and the development of hepatocellular carcinoma. However, the prevalence of O-HBV has not been clearly established in certain at-risk populations, such as injection drug users. METHODS: Therefore, the current pilot study examined the prevalence of O-HBV in a prospective cohort designed to assess the role of injection and non-injection drug use (IDU) on HIV-associated comorbidities. RESULTS: Utilizing two distinct real-time polymerase chain reaction assays, HBV DNA was not detected in 99 participants examined. CONCLUSION: This finding is in contrast to other data from US IDU cohorts and suggests that the prevalence of O-HBV infection is very specific to the cohort studied, is sensitive to other confounding variables such as hepatitis C virus and/or HIV serostatus, and should not be generalized across risk groups or distinct cohorts.

Recommendations for smooth career transitions in pharmacy leadership.

The Director's Forum is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. This article focuses on the process of preparing leaders for future career transitions. Both new and seasoned leaders are confronted with the tasks of overcoming environmental issues, ensuring alignment in all directions during the first 90 days, and implementing change. By gaining a thorough understanding of the expectations during the transition phase, the new pharmacy leader will ensure future successes that maximize department initiatives and support the rapidly changing health care environment.

Analysis of a non-structural gene reveals evidence of possible hepatitis C virus (HCV) compartmentalization.

Viral diversity is a hallmark of hepatitis C virus (HCV) infection; however, only limited data are available regarding HCV variability in extrahepatic sites, and none have systematically compared diversity in non-structural and structural genomic regions. Therefore, HCV diversity in the NS5B and envelope 1 (E1) hypervariable region 1 (HVR1) genes was evaluated in matched sera and peripheral blood mononuclear cells (PBMCs) obtained from 13 HCV-infected women. Multiple clonal sequences were compared to evaluate quasispecies diversity and viral compartmentalization in PBMCs. Genetic distances were higher for E1/HVR1 compared to NS5B in both the sera and PBMCs (P = 0.0511 and 0.0284). Genetic distances were higher in serum NS5B compared to PBMC NS5B (P = 0.0003); however, they were not different when comparing E1/HVR1 in sera to PBMCs. By phylogenetic analysis of NS5B, evidence of possible PBMC compartmentalization was observed for one woman, while statistical methods were consistent with PBMC compartmentalization for six women. Evidence of compartmentalization within a non-structural genomic region may suggest that viral adaptation to a unique extracellular microenvironment(s) may be required for efficient replication and could contribute to HCV persistence.

Racial and ethnic differences in diurnal cortisol rhythms in preadolescents: the role of parental psychosocial risk and monitoring.

Racial/ethnic minorities experience persistent health disparities due in part to their exposure to chronic SES and psychosocial risk. The hypothalamic-pituitary-adrenal axis and its hormonal end product, cortisol, are believed to mediate the associations between chronic stress and poor health. In this study, racial/ethnic differences in diurnal salivary cortisol rhythms in 179 preadolescent youths and the contributing roles of SES risk, psychosocial risk, perceived discrimination, harsh parenting, and parental monitoring were examined. The analyses revealed racial/ethnic differences in diurnal cortisol rhythms, with African Americans having significantly flatter morning-to-evening cortisol slopes than Caucasians and with Latinos having significantly lower evening cortisol levels than Caucasians. Greater psychosocial risk and less parental monitoring were associated with flatter cortisol slopes. Racial/ethnic differences on the cortisol measures persisted when controlling for SES, psychosocial risk, and parenting quality. The need to assess chronic risk across the lifespan and disentangle possible genetic from environmental contributors is discussed.

Personal exposure to specific volatile organic compounds and acute changes in lung function and heart rate variability among urban cyclists.

BACKGROUND: Few studies have examined the acute cardiorespiratory effects of specific volatile organic compound (VOC) exposures from traffic pollution. METHODS: A cross-over study was conducted among 42 healthy adults during summer 2010 in Ottawa, Canada. Participants cycled for 1-h along high and low-traffic routes and VOC exposures were determined along each route. Lung function, exhaled nitric oxide, and heart rate variability were monitored before cycling and 1-4h after the start of cycling. Bayesian hierarchical models were used to examine the relationship between 26 VOCs and acute changes in clinical outcomes adjusted for potential confounding factors. RESULTS: Each inter-quartile range (IQR) increase in propane/butane exposure was associated with a 2.0 millisecond (ms) (95% CI: 0.65, 3.2) increase in SDNN (standard deviation of normal-to-normal intervals), a 24 ms(2) (95% CI: 6.6, 41) increase in HF (high frequency power), and a 65 ms(2) (95% CI: 11, 118) increase in LF (low frequency power) in the hours following cycling. IQR increases in ethane and isoprene were associated with a 5.8 ms (95% CI: -9.8, -1.7): decrease in SDNN and a 24 ms(2) (95% CI: -44, -7.9) decrease in HF, respectively. IQR increases in benzene exposure were associated with a 1.7 ppb (95% CI: 1.1, 2.3) increase in exhaled nitric oxide and each IQR increase in 3-methylhexane exposure was associated with a 102 mL (95% CI: -157, -47) decrease in forced expiratory volume in 1-s. CONCLUSIONS: Exposure to traffic-related VOCs may contribute to acute changes in lung function, inflammation, or heart rate variability.

Risk for maternal harsh parenting in high-risk families from birth to age three: does ethnicity matter?

Child maltreatment prevention programs typically identify at-risk families by screening for risk with limited consideration of how risk might vary by ethnicity. In this study, longitudinal data from mothers who participated in a randomized clinical trial of a home-visitation, child maltreatment prevention program (N = 262) were examined to determine whether risk for harsh parenting differed among mothers who identified themselves as Spanish-speaking Latinas (n = 64), English-speaking Latinas (n = 102), or non-Latina Caucasians (n = 96). The majority of the participants were first-time mothers (58.4%), and the average age of all participants was 23.55 years (SD = 6.04). At the time of their infants' births, the Spanish-speaking Latina mothers demonstrated higher SES risk, whereas the English-speaking Latina and non-Latina Caucasian mothers demonstrated higher psychosocial risk. Three years later, the English-speaking Latina and non-Latina Caucasian mothers reported harsher parenting behaviors than the Spanish-speaking Latina mothers. The need for prevention programs to consider how risk and protective factors differ by ethnic group membership when identifying at-risk mothers is discussed.

Direct and indirect associations among mothers' invalidating childhood environment, emotion regulation difficulties, and parental apology.

BACKGROUND: Effective emotion regulation abilities are essential for engaging in positive, validating parenting practices. Yet, many parents report difficulties with both emotion regulation and positive parenting, and these difficulties may in part be the result of parents' own childhood experiences of invalidation. Building upon prior literature documenting the intergenerational transmission of invalidation and emotion dysregulation, the present study examined the associations between these constructs and a specific parenting practice - parental apology - that can be conceptualized as a type of validating parenting practice. METHODS: Using a sample of 186 community mothers, we tested direct and indirect relationships via correlational and path analysis between participants' retrospective reports of parental invalidation during childhood, difficulties with emotion regulation, and two aspects of parental apology - proclivity (i.e., participants' self-reported propensity to apologize to their child) and effectiveness (i.e., participants' inclusion of specific apology content when prompted to write a child-directed apology). Parental invalidation, difficulties with emotion regulation, and parental apology proclivity were measured via self-report questionnaires. Apology effectiveness was measured by coding written responses to a hypothetical vignette. RESULTS: There was a significant negative bivariate relationship between difficulties with emotion regulation and parental apology proclivity and effectiveness. Parents' own childhood experiences of invalidation were linked to parental apology indirectly via emotion regulation difficulties. CONCLUSIONS: Results suggest that mothers with greater difficulties regulating emotions may be less able to or have a lower proclivity to apologize to their child when appropriate. Thus, parent apology may be an important addition to current calls for parent validation training.

Hepatitis B virus (HBV) X gene diversity and evidence of recombination in HBV/HIV co-infected persons.

The high frequency of mutation during hepatitis B virus (HBV) infection has resulted in 8 genotypes (A-H) with varying effects on disease severity and treatment efficacy. However, analysis of intrapatient HBV diversity is limited, especially during HIV co-infection. Therefore, a preliminary study was performed to analyze HBV X gene diversity in 17 HBV/HIV co-infected individuals. Phylogenetic analysis revealed HBV genotype A in 13 individuals (76.5%) or genotype E in 1 individual (5.9%). Additionally, 3 individuals were dually infected with HBV genotypes A and G (17.6%). Overall, higher genetic distance and entropy were observed in the X region and overlapping polymerase (Pol(X)) regions when compared to the PreS, S, and overlapping polymerase (Pol(PS) and Pol(S)) regions analyzed in the same patients as part of a previous study. In addition, multiple viral variants from 2 individuals with dual HBV infection did not group with either genotype A or G by phylogenetic analysis, indicating possible recombination. SimPlot bootscan analysis confirmed recombination breakpoints within the X gene in both individuals. Recombination between HBV genotypes may represent an important evolutionary strategy that enhances overall pathogenic potential and/or alters the downstream effects of the HBV X protein.

A Systematic Review Focusing on Psychotherapeutic Interventions that Impact Parental Psychopathology, Child Psychopathology and Parenting Behavior.

Given the high rates of co-occurrence of psychopathology within families, it is important to identify and characterize interventions that simultaneously reduce both parent and child symptoms, and improve parenting quality. This is needed as intervention development is increasingly moving toward integrated interventions that target some combination of parent and child mental health, and parenting behavior. Even so, much remains unknown regarding which treatment components provide maximum benefit for parent symptoms, child symptoms, and parenting behavior. This systematic review identified and characterized psychotherapeutic interventions that report improvements in each of three outcomes: parent symptoms, child symptoms and parenting behavior. Fifty-six unique interventions were eligible for review, of which 25 reported improvements in all three outcomes. All 25 of these interventions directly intervened on parenting behavior, often as the sole target of the intervention. Few interventions improved all three outcomes in samples in which parents, children or both met clinical-level thresholds of psychopathology. Additional research is needed to better understand the bi-directional and transactional influences of treatment on family members, and to better inform the development of interventions for dually disordered parent-child dyads across a range of diagnostic profiles.

A rare case of diffuse alveolar hemorrhage caused by acute mycoplasma pneumoniae pneumonia.

Mycoplasma pneumoniae is a common bacterial pathogen that causes atypical community-acquired pneumonia. Illness onset can be gradual and progressive over weeks. Patients typically have cough, pharyngitis, malaise, and tracheobronchitis. Although symptoms are frequently mild, the initial presentation can be severe with numerous complications. We present a case of a 28-year-old male who presented with 1 day of significant hemoptysis. He was intubated for airway protection and underwent bronchoscopy, which showed multiple blood clots in several lung lobes, consistent with diffuse alveolar hemorrhage (DAH). His workup was negative for pulmonary embolism, coagulopathy, and vasculitis. He tested positive for rhinovirus and mycoplasma pneumoniae IgM (negative IgG). He was ultimately discharged home with oral doxycycline to complete a 10-day course. DAH is a rare presentation and life-threatening complication of mycoplasma pneumonia. Although there is a reported association between DAH and rhinovirus, our patient improved with antibiotics making mycoplasma pneumoniae the likely culprit. When encountering hemoptysis or alveolar bleeding, clinicians should have low suspicion for atypical infections and start appropriate antibiotics early in the clinical course.