Stressors, emotions, and social support systems among respiratory nurses during the Omicron outbreak in China: a qualitative study.

BACKGROUND: Respiratory nurses faced tremendous challenges when the Omicron variant spread rapidly in China from late 2022 to early 2023. An in-depth understanding of respiratory nurses' experiences during challenging times can help to develop better management and support strategies. The present study was conducted to explore and describe the work experiences of nurses working in the Department of Pulmonary and Critical Care Medicine (PCCM) during the Omicron outbreak in China. METHODS: This study utilized a descriptive phenomenological method. Between January 9 and 22, 2023, semistructured and individual in-depth interviews were conducted with 11 respiratory nurses at a tertiary hospital in Wuhan, Hubei Province. A purposive sampling method was used to select the participants, and the sample size was determined based on data saturation. The data analysis was carried out using Colaizzi's method. RESULTS: Three themes with ten subthemes emerged: (a) multiple stressors (intense workload due to high variability in COVID patients; worry about not having enough ability and energy to care for critically ill patients; fighting for anxious clients, colleagues, and selves); (b) mixed emotions (feelings of loss and responsibility; feelings of frustration and achievement; feelings of nervousness and security); and (c) a perceived social support system (team cohesion; family support; head nurse leadership; and the impact of social media). CONCLUSION: Nursing managers should be attentive to frontline nurses' needs and occupational stress during novel coronavirus disease 2019 (COVID-19) outbreaks. Management should strengthen psychological and social support systems, optimize nursing leadership styles, and proactively consider the application of artificial intelligence (AI) technologies and products in clinical care to improve the ability of nurses to effectively respond to future public health crises.

A Social Media-Based Mindfulness Psycho-Behavioral Intervention (MCARE) for Patients With Acute Coronary Syndrome: Randomized Controlled Trial.

BACKGROUND: Psychological distress is common among patients with acute coronary syndrome (ACS) and has considerable adverse impacts on disease progression and health outcomes. Mindfulness-based intervention is a promising complementary approach to address patients' psychological needs and promote holistic well-being. OBJECTIVE: This study aims to examine the effects of a social media-based mindfulness psycho-behavioral intervention (MCARE) on psychological distress, psychological stress, health-related quality of life (HRQoL), and cardiovascular risk factors among patients with ACS. METHODS: This study was a 2-arm, parallel-group randomized controlled trial. We recruited 178 patients (mean age 58.7, SD 8.9 years; 122/178, 68.5% male) with ACS at 2 tertiary hospitals in Jinan, China. Participants were randomly assigned to the MCARE group (n=89) or control group (n=89). The 6-week intervention consisted of 1 face-to-face session (phase I) and 5 weekly WeChat (Tencent Holdings Ltd)-delivered sessions (phase II) on mindfulness training and health education and lifestyle modification. The primary outcomes were depression and anxiety. Secondary outcomes included psychological stress, HRQoL, and cardiovascular risk factors (ie, smoking status, physical activity, dietary behavior, BMI, blood pressure, blood lipids, and blood glucose). Outcomes were measured at baseline (T0), immediately after the intervention (T1), and 12 weeks after the commencement of the intervention (T2). RESULTS: The MCARE group showed significantly greater reductions in depression (T1: ß=-2.016, 95% CI -2.584 to -1.449, Cohen d=-1.28, P<.001; T2: ß=-2.089, 95% CI -2.777 to -1.402, Cohen d=-1.12, P<.001) and anxiety (T1: ß=-1.024, 95% CI -1.551 to -0.497, Cohen d=-0.83, P<.001; T2: ß=-0.932, 95% CI -1.519 to -0.346, Cohen d=-0.70, P=.002). Significantly greater improvements were also observed in psychological stress (ß=-1.186, 95% CI -1.678 to -0.694, Cohen d=-1.41, P<.001), physical HRQoL (ß=0.088, 95% CI 0.008-0.167, Cohen d=0.72, P=.03), emotional HRQoL (ß=0.294, 95% CI 0.169-0.419, Cohen d=0.81, P<.001), and general HRQoL (ß=0.147, 95% CI 0.070-0.224, Cohen d=1.07) at T1, as well as dietary behavior (ß=0.069, 95% CI 0.003-0.136, Cohen d=0.75, P=.04), physical activity level (ß=177.542, 95% CI -39.073 to 316.011, Cohen d=0.51, P=.01), and systolic blood pressure (ß=-3.326, 95% CI -5.928 to -0.725, Cohen d=-1.32, P=.01) at T2. The overall completion rate of the intervention (completing ≥5 sessions) was 76% (68/89). Positive responses to the questions of the acceptability questionnaire ranged from 93% (76/82) to 100% (82/82). CONCLUSIONS: The MCARE program generated favorable effects on psychological distress, psychological stress, HRQoL, and several aspects of cardiovascular risk factors in patients with ACS. This study provides clues for guiding clinical practice in the recognition and management of psychological distress and integrating the intervention into routine rehabilitation practice. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2000033526; https://www.chictr.org.cn/showprojEN.html?proj=54693.

Alterations of the gut microbiota and fecal short-chain fatty acids in women undergoing assisted reproduction.

CONTEXT: The community structure of gut microbiota changes during pregnancy, which also affects the synthesis of short-chain fatty acids (SCFAs). However, the distribution of gut microbiota composition and metabolite SCFA levels are poorly understood in women undergoing assisted reproductive technology (ART). AIMS: To evaluate the changes in gut microbiota composition and metabolic SCFAs in women who received assisted reproduction treatment. METHODS: Sixty-three pregnant women with spontaneous pregnancy (SP) and nine with ART pregnancy were recruited to provide fecal samples. Gut microbiota abundance and SCFA levels were determined by 16S ribosomal RNA (rRNA) gene amplicon sequencing and gas chromatography-mass spectrometry (GC-MS). KEY RESULTS: The ART group showed decreased alpha diversity (the species richness or evenness in a sample). The principal coordinates analysis (a method of analysing beta diversity) showed significant difference in gut microbiota between the ART group versus the SP group (unweighted UniFrac distance, R 2 =0.04, P =0.003). Proteobacteria , Blautia and Escherichia-Shigella were enriched in the ART group, whereas the relative abundance of beneficial intestinal bacteria Faecalibacterium was lower than in the SP group. Different modes of conception were associated with several SCFAs (valeric acid (r =-0.280; P =0.017); isocaproic acid (r =-0.330; P =0.005); caproic acid (r =-0.336; P =0.004)). Significantly different SCFAs between the two groups were synchronously associated with the differential gut microbiota. CONCLUSIONS: The diversity and abundance of gut microbiota and the levels of SCFAs in women undergoing ART decreased. IMPLICATIONS: The application of ART shaped the microbial composition and metabolism, which may provide critical information for understanding the biological changes that occur in women with assisted reproduction.

Factors influencing nurses self-efficacy two years after the COVID-19 outbreak: A cross-sectional study in Wuhan, China.

This study explored the anxiety, depression, and self-efficacy of nurses in Wuhan, China 2 years after the corona virus disease 2019 outbreak. A total of 552 nurses were enrolled in the study. Four well-established test tools were applied: The 9-item patient health questionnaire, The 7-item generalized anxiety disorder, generalized self-efficacy scale, Connor Davidson resilience scale. Twenty-eight points twenty-six percentage of the nurses had mild depression, and 5.62% had moderate or severe depression. Twenty-one points seventy-four percentage of nurses had mild anxiety and 1.82% had moderate or severe anxiety. The average score of self-efficacies is negatively correlated with the average score of the 9-item patient health questionnaire (r = -0.303, P < .01), and the7-item generalized anxiety disorder (r = -0.275, P < .01). The average score of self-efficacies is correlated with the resilience score (R = 0.799, P < .01). Through multiple linear regression analysis, the tenacity dimension and monthly income are most closely related to the sense of self-efficacy. Nurses self-efficacy and resilience are important factors in promoting their psychological well-being. This study suggests that increasing the salary and providing some strategies to increase nurses mental tenacity can promote self-efficacy.

The effects of nurse-led family pulmonary rehabilitation intervention on quality of life and exercise capacity in rural patients with COPD.

AIM: To assess the effects of nurse-led family pulmonary rehabilitation intervention on quality of life and exercise capacity in rural patients with chronic obstructive pulmonary disease (COPD). DESIGN: A non-randomized clinical trial. METHODS: This study enrolled COPD patients at two hospitals from January 2019 to January 2020. The primary outcome was the quality of life. The secondary outcome was exercise capacity. RESULTS: Seventy-four rural COPD patients were enrolled, 38 in the comprehensive nursing group and 36 in the routine nursing group. After the intervention, the St. George's Respiratory Questionnaire (SGRQ) scores in the comprehensive nursing group were significantly lower than in the routine nursing group, especially in symptoms, activities and total scores. The SGRQ scores of the comprehensive nursing group were significantly lower than baseline, while the SGRQ scores of the routine nursing group were significantly higher than baseline. After the intervention, there was a significant difference in six-minute walking distance(6MWD) between the two groups.

Effects of Structured Expressive Writing on Quality of Life and Perceived Self-Care Self-Efficacy of Breast Cancer Patients Undergoing Chemotherapy in Central China: A Randomized Controlled Trial.

Expressive writing is a supportive psychological intervention allowing an individual to disclose and express their deepest thoughts and feelings related to personal traumatic experiences through writing. Previous studies suggested that expressive writing could promote the physical and mental health of cancer patients. The current study was conducted to evaluate the effect of expressive writing based on the theory of cognitive adaptation (TCA) on the quality of life and self-care self-efficacy in patients with breast cancer undergoing chemotherapy. A sample of 82 Chinese women receiving chemotherapy for breast cancer was randomly assigned to an experimental group (four 20 min writing activities focusing on emotional disclosure) or a control group (no writing activities). The quality of life (QoL) and self-care self-efficacy were assessed at baseline, 2 weeks, 4 weeks, and 6 weeks after the intervention, respectively. The sociodemographic characteristics, QoL, and self-care self-efficacy at baseline were comparable between the two groups. Repeated-measures ANOVA revealed significant effects of the time×group (F = 3.65, p < 0.05) on the QoL and significant effects of time (F = 4.77, p <0.05) on self-care self-efficacy. Compared with the control group, the QoL in the intervention group showed a significant and temporary increase at 2 weeks after the intervention (mean difference = −7.56, p < 0.05). As a low-cost and easily delivered psychological intervention, expressive writing is recommended to reduce stress when there is a lack of available emotional support.

Research on depression in Parkinson disease: A bibliometric and visual analysis of studies published during 2012-2021.

BACKGROUND: The diagnosis and treatment rate of Parkinson disease (PD) with depression has a low diagnostic rate, and there is no consensus on the choice of treatment mode. This study evaluates the global research trends of scientific outputs related to depression in PD from multiple perspectives, using a bibliometric analysis and visualization tool to scientifically analyze the knowledge from the literature. METHODS: Literature related to depression in PD published from 2012 to 2021 was included and selected from the Web of Science Core Collection database in October 2021. CiteSpace software was used to visualize and analyze co-occurrence analyses for countries, institutions, authors, and keywords. RESULTS: A total of 4533 articles from the Web of Science database were included. The United States made the largest contribution with the majority of publications (1215; 29.40%). Toronto University was the most productive institution. PD, depression, quality of life, dementia, nonmotor symptom, prevalence, anxiety, Alzheimer disease, symptom, and disorder would be significantly correlated with depression in PD. The current hot spots in this field focus on the following: risk factors for depression in PD, assessment scale of depression in PD, and rehabilitation of depression in PD. CONCLUSIONS: This analysis not only reveals the current research trends and hotspots but also provides some instructive suggestions on the development of depression in PD.

Factors associated with burnout among Chinese nurses during COVID-19 epidemic: a cross-sectional study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) epidemic has broken out and even spread globally. The healthcare system worldwide faces enormous challenges, and nurses are at the highest risk as one of the leading forces. It's worth paying attention to nurses' anxiety and job burnout. This study aimed to investigate nurses' levels of burnout and anxiety during the epidemic of COVID-19 and to analyze influencing factors of burnout. METHODS: A cross-sectional survey was conducted from 19 to 25 February 2020. Questionnaires such as the basic information questionnaire, Maslach Burnout Inventory-General Survey (MBI-GS), and State-Trait Anxiety Inventory (STAI) were used among 1011 nurses in Wuhan tertiary hospitals via the online survey. The final number of valid questionnaires was 885. The effective response rate was 87.5%. RESULTS: The average score of MBI-GS was 11.50, 6.02, 24.47, respectively. The average score for state anxiety was 45.52 and trait anxiety, 43.78. Anxiety was positively associated with emotional exhaustion and cynicism, and negatively related to personal accomplishment. The protective factors of burnout were personnel agency, five years or less work experience, living in hospital dormitory, Wuhan medical team, working time exceeding 9 h, and the best knowledge of COVID-19. The absence of siblings, median job title, working in isolation wards, three or more night shifts per week, living in hotels, and being surrounded by confirmed or suspected medical staff were all negative factors. CONCLUSIONS: Nurses had high anxiety levels during the COVID-19 period, but the level of burnout was mild to moderate. Managers should continue to pay attention to nurses' psychological state and related factors and intervene to stabilize the nursing team.

One-year follow-up of 18 women who infected COVID-19 while pregnant.

Data about the sequelae of women who infected COVID-19 while pregnant are scarce. We aimed to describe the prevalence of symptoms, pulmonary functions, and radiological changes at a follow-up of 12 months in 18 pregnant women who developed COVID-19 at different gestational ages. Our results showed that most women who infected COVID-19 while pregnant experienced a progressive improvement of their symptoms within 12 months, however, some still had little COVID-related symptoms but without a reduced quality of life. All their 18 newborns were growing up healthy.

Factors influencing risk perception and nosocomial infection prevention practices of frontline nurses during the COVID-19 pandemic.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, exploring factors influencing nosocomial infection among frontline nurses may provide evidence to optimize prevention strategies in hospitals. METHOD: A large-scale online questionnaire survey of nurses' state-trait anxiety, job burnout, risk perception, workplace safety perception, knowledge about nosocomial infection, and preventive practices was conducted with 2795 frontline nurses working in the COVID-19 wards of six hospitals in Hubei Province, China, from February 1 to April 1, 2020. The questionnaire data were analyzed using the structural equation modeling (SEM) method to reveal the mechanisms influencing nurses' risk perception and preventive practices related to nosocomial COVID-19 infection. RESULTS: A model of the factors that influence nurses' risk perception and preventive practices regarding nosocomial COVID-19 infection was established. The model verified hypotheses regarding the impact of nurses' risk perception and preventive practices. Notably, the hypothesis that risk perception has an impact on nurses' preventive practices regarding nosocomial infection is not valid. Moreover, different marital and educational conditions are associated with significant differences in the impact of state anxiety on the execution of preventive practices, the impact of workplace safety perceptions on risk perception, and the impact of workplace safety perceptions on the execution of preventive practices. The effect of state anxiety on preventive practices differed significantly with different durations of work experience. CONCLUSIONS: According to the results of the influencing factor model, promoting the quality of training on nosocomial infection, meliorating workplace safety, and conducting timely and effective psychological interventions would aid in improving nurses' preventive practices. Meliorating workplace safety and easing state anxiety would be beneficial to reduce nurses' risk perception. These strategies are conducive to the optimization of policies for preventing nosocomial COVID-19 infections and similar infectious diseases.

Resolution of Coronavirus Disease 2019 Infection and Pulmonary Pathology With Nebulized DAS181: A Pilot Study.

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 infections commonly lead to respiratory failure and potentially fatal systemic inflammation and organ failure. Nebulized DAS181, a host-directed biologics with sialidase activity, is an investigational drug with antiviral activities on parainfluenza and influenza under phase 3 and phase 2 development. The objective of this study (NCT04324489) is to investigate the safety and effects of nebulized DAS181 on hypoxic coronavirus disease 2019 patients. DESIGN: Single-center, prospective, open-label, compassionate use. SETTING: Renmin Hospital of Wuhan University, Department of Respiratory and Critical Care Medicine and Department of Infectious Diseases. SUBJECTS: Patients 18 to 70 years old who met Chinese criteria for severe coronavirus disease 2019 pneumonia and required supplemental oxygen but not on mechanical ventilator at screening. INTERVENTIONS: Nebulized DAS181 (4.5 mg) twice a day for 10 days. MEASUREMENTS AND MAIN RESULTS: Three male coronavirus disease 2019 hypoxic patients with bilateral lung involvement completed DAS181 treatment for 10 days. By day 14, all achieved return to room air (primary endpoint) and their nasopharyngeal swabs were negative for severe acute respiratory syndrome coronavirus 2. Clinical severity improved from severe coronavirus disease 2019 at baseline to moderate or mild disease by day 5, consistent with rapid reduction of inflammatory cytokines by days 2-3 and radiologic improvement by days 5-10. No DAS181-related adverse events were reported. CONCLUSIONS: Inhalation of DAS181 was well tolerated and potential clinical benefit of DAS181 on hypoxic coronavirus disease 2019 is the reduction of supplemental oxygen need. Efficacy and safety, including pharmacokinetics and viral studies of DAS181 in severe, hypoxic coronavirus disease 2019, should be examined by a double-blind, randomized controlled study.

[Effects of different doses of 5-HT receptor ligands on genioglossus discharge in chronic intermittent hypoxia rats].

OBJECTIVE: To explore the effects of different doses of 5-HT2A/2CR agonist or 5-HT2AR antagonist on genioglossus discharge in chronic intermittent hypoxia rats. METHODS: Thirty adult male Sprague-Dawley rats, each 180-200 g, were randomly divided into the normoxia group (group A, n=5) and the chronic intermittent hypoxia group (CIH group, n=25) by the random number table. The rats in the CIH group were fed in the intermittent hypoxia animal chambers, while the normoxia control group was placed in the normoxia animal chambers for 8 h per day for 4 consecutive weeks. After 28 days, 5 min×3 times of stimulation with acute intermittent hypoxia (AIH) were given and the genioglossus muscle activity were then recorded and compared before and after intravenous injection of saline (group B, n=5), the 5-HT2A/2CR agonist 30 µg/3 µl (group C, n=5) or 50 µg/5 µl group (group D, n=5), 5-HT2AR antagonist 10 µg/1 µl (group E, n=5) or 70 µg/7 µl (group F, n=5). RESULTS: The average peak amplitude in 60 min of genioglossus muscle activity in the CIH saline control group (group B) was significantly higher than that in the normoxia group (group A), while the genioglossus discharge in the 2 groups were (42.29 ± 1.78) µV, (25.38 ± 0.89) µV respectively (P<0.01). The 5-HT2A/2CR agonist (30 µg/3 µl or 50 µg/5 µl) caused the amplitude of genioglossus muscle activity firstly to increase and then to decrease, with the peak changes showing statistical difference (P<0.05). 10 µg/1 µl 5-HT2AR antagonist did not influence genioglossus muscle activity (P>0.05), however, after intravenous injection of 70 µg/7 µl 5-HT2AR antagonist, the amplitude of genioglossus discharge firstly decreased and then gradually returned to baseline level, the difference being statistically significant, P<0.01. CONCLUSION: Our results indicate that CIH strengthens the genioglossus discharge in CIH rats. The 5-HT2A/2CR agonist can strengthen the genioglossus discharge but the 5-HT2AR antagonists can weaken the effect, both of which have dose-related effects.

[The influence of intermittent hypoxia on long-term facilitation of hypoglossal nerve discharge in spontaneously breathing rats].

OBJECTIVE: To explore the impact of intermittent hypoxia on long-term facilitation (LTF) of hypoglossal nerve discharge. METHODS: Twelve adult SD rats were divided into the experimental group (CIH group, n = 6) and the control group (normoxia group, n = 6) by the random number table. The rats in the CIH group were fed in the intermittent hypoxia animal chambers, while the control group was placed in the normoxia animal chambers for 8 h per day (from 8:00 AM to 4:00 PM) for 4 consecutive weeks. After that, 5 min×3 stimulations of acute intermittent hypoxia (AIH) were administered and the hypoglossal never signals were recorded before and after AIH. RESULTS: The baseline frequency and average peak amplitude of hypoglossal nerve discharge in the CIH experimental group were significantly greater than those in the control group. The discharge frequency in the CIH and the control groups was (73 ± 13) Hz, and (58 ± 11) Hz, respectively(P < 0.05); and the discharge amplitude in the 2 groups was (4.6 ± 1.1) µV, and (3.3 ± 0.7) µV, respectively(P < 0.05). After intervention with AIH, the frequency and the average peak amplitude of the hypoglossal nerve discharge in the experimental and the control groups were significantly increased(all P < 0.05). The increased discharge lasted more than 1 h and this typical phenomenon was referred to as LTF. In the CIH group, the discharge frequency before and after exposure to AIH was (68 ± 16) Hz and (133 ± 20) Hz, respectively; and the discharge amplitude was (4.6 ± 1.1) µV and (8.9 ± 1.4) µV, respectively. In the control group, the discharge frequency before and after AIH was (59 ± 12) Hz and (102 ± 16) Hz, respectively; and the discharge amplitude was (3.3 ± 0.7) µV and (4.5 ± 0.7) µV, respectively(P < 0.05). After AIH stimulation, the enhanced respiratory intensity of rats in CIH group was much higher than that in the control group [(408 ± 149)% vs (242 ± 31)%, P < 0.05]. CONCLUSION: Both AIH and CIH can induce LTF of the hypoglossal nerve discharge, while the induction of LTF by AIH can be strengthened by CIH.

Polymorphisms of the 5-hydroxytryptamine 2A/2C receptor genes and 5-hydroxytryptamine transporter gene in Chinese patients with OSAHS.

BACKGROUND: It is known that there is a genetic predisposition to OSAHS. Polymorphisms of the 5-hydroxytryptamine (5-HT) 2A/2C receptors (5-HTR 2A/2C) genes and 5-HT transporter (5-HTT) gene may be associated with the pathogenesis of obstructive sleep apnea-hypopnea syndrome (OSAHS). OBJECTIVES: In this study, we aimed to investigate the prevalence of polymorphisms of the 5-HTR 2A/2C genes and the 5-HTT gene in the Chinese Han OSAHS population. METHODS: A total of 226 unrelated subjects of the Chinese Han population, including 121 OSAHS patients and 105 healthy controls, were involved in the study. The A1438G and T102C polymorphisms of the 5-HTR 2A gene, G796C polymorphisms of the 5-HTR 2C gene, and two polymorphisms (gene-linked polymorphic region [LPR] and variable number tandem repeat [VNTR]) of the 5-HTT gene were identified by polymerase chain reaction (PCR)-RFLP. RESULTS: Compared with the control group, the OSAHS group had significantly higher AA genotype and A allele frequencies in the A1438G polymorphisms of the 5-HTR 2A gene, and had significantly higher frequencies of 10/10, 12/10 genotypes and the allele 10 of 5-HTT-VNTR. There were no significant differences between the genotype distribution and allele frequencies of the OSAHS group and the control group regarding the T102C polymorphisms of the 5-HTR 2A gene and the G796C polymorphisms of the 5-HTR 2C gene, the frequencies of the S or L allele and the S/S, S/L or L/L genotypes in 5-HTT-LPR. CONCLUSIONS: The A1438G polymorphism of the 5-HTR 2A gene might be involved in the pathogenesis in OSAHS subjects of the Chinese Han population. Meanwhile, our findings support the argument that 5-HTT polymorphism appears to be associated with susceptibility to OSAHS, because the allele 10 of 5-HTT-VNTR might be a susceptible factor.

Investigation of the relationships among workplace stressors, ways of coping, and the mental health of Chinese head nurses.

Limited information exists about which workplace events are stressful for nurses in charge of a hospital patient-care unit (head nurse) in China and how these nurses cope with these events. Therefore, the purposes of this descriptive study were to examine workplace stressors, ways of coping, and the levels of mental health of Chinese head nurses, as well as to identify the relationships among the workplace stressors, ways of coping, and mental health of Chinese head nurses. To address these purposes, four self-report questionnaires were administered to a convenience sample of 92 head nurses from two teaching hospitals located in one city in central China. The findings suggested that workload, death/dying, and conflict with physicians were the most predominant sources of workplace stress, while the most frequent coping strategies used were positive reappraisal, planful problem solving, and self-control. The mental health scores were found to be lower than prior research has suggested for some nurses in Asia. A number of significant correlations were found among demographic characteristics, workplace stressors, ways of coping, and mental health.