Self-Esteem Among U.S. African American and Latinx Adolescents With Depressive Symptoms and Overweight and/or Obesity.

PURPOSE: To examine the concept of self-esteem among African American and Latinx adolescents with overweight and/or obesity and depressive symptoms in the United States. METHOD: Using key terms in CINAHL, PubMed, and PsycINFO databases, an initial search yielded 371 articles; after examining title, abstract, and full text, 33 articles remained. The concept of adolescent self-esteem was analyzed using Rodger's evolutionary method. RESULTS: Several antecedents of self-esteem in this context were identified, including bullying, negative portrayal in the media, stressors and hassles, low socioeconomic status, dieting, and family dietary influences. Attributes identified were body image and misperception, body image dissatisfaction, diminished social status, and isolation. Consequences included stigma, somatic complaints, decreased earnings over a lifetime, decreased quality of life, lower educational attainment over a lifetime, and increased substance use. Increased self-esteem, increased number of friends, and in-depth friendships were associated with a lower risk of being overweight or obese. CONCLUSION: Adolescent self-esteem varied based on gender, racial and ethnic group, and changed over time in the African American population but remained static in the Latinx population. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Using Mixed Methods Research in Children with Type 1 Diabetes: a Methodological Review.

PURPOSE OF REVIEW: Many factors influence disease management and glycemic levels in children with type 1 diabetes (T1D). However, these concepts are hard to examine in children using only a qualitative or quantitative research paradigm. Mixed methods research (MMR) offers creative and unique ways to study complex research questions in children and their families. RECENT FINDINGS: A focused, methodological literature review revealed 20 empirical mixed methods research (MMR) studies that included children with T1D and/or their parents/caregivers. These studies were examined and synthesized to elicit themes and trends in MMR. Main themes that emerged included disease management, evaluation of interventions, and support. There were multiple inconsistencies between studies when reporting MMR definitions, rationales, and design. Limited studies use MMR approaches to examine concepts related to children with T1D. Findings from future MMR studies, especially ones that use child-report, may illuminate ways to improve disease management and lead to better glycemic levels and health outcomes.

Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review.

OBJECTIVES: The number of infants and children requiring extracorporeal membrane oxygenation (ECMO) is rising. While critically ill, providers may believe that enteral nutrition puts the patient at risk for severe complications such as necrotizing enterocolitis. However, enteral nutrition is associated with the potential to improve the gut barrier and reduce the risk of morbidity and mortality. The purpose of this article is to review the existing evidence about providing exclusive enteral and parenteral nutrition and its association with rates of complications and mortality in critically ill neonatal and pediatric populations on ECMO. DATA SOURCES: Literature addressing enteral nutrition while on ECMO for neonatal and pediatric populations was searched using PubMed, CINAHL, and Scopus. STUDY SELECTION: Studies ranged from 1998 to 2022 and were conducted mostly in the PICU and neonatal ICU settings. DATA EXTRACTION: Fourteen articles were reviewed after inclusion and exclusion criteria were applied. DATA SYNTHESIS: Characteristics included an even number of males and females in samples from mostly PICUs. The predominant underlying illnesses were neonatal pulmonary disease and cardiac disease. Upon reviewing the literature, three major themes were revealed: no significant complications with enteral feeding, underutilization of enteral feeding, and reduced mortality with enteral feeding. CONCLUSION: The use of enteral nutrition in the neonatal and pediatric population while on ECMO has the potential to improve survival rates and reduce complications. Further studies are needed to investigate how to optimize this population's nutrition and develop feeding protocols and pathways.

Definitions, theories, and measurement of stress in children.

PROBLEM: Stress in children remains a complex concept to examine due to the inherent subjectivity and lack of specific manifestations, as well as the multiple ways stress can be defined and measured in children. Because stress is multifactorial,is experienced daily by children, and undergirds adolescent health and early mental illness, it is crucial to have a clear understanding of stress and the effects of stress in children from infancy through age twelve years. ELIGIBILITY CRITERIA: To be included in this review, literature must pertain to and highlight theories, definitions/classifications, and measurements of stress in children from infancy to 12 years of age. SAMPLE: The most pertinent articles identified through database searches (PubMed, Scopus, PsycINFO, CINAHL, Google Scholar), gray literature sources (e.g., child health websites), and reference lists of identified articles were included in this narrative overview. RESULTS: The results of this review are organized by themes and include: classifications and definitions of stress, stress-related theories, and tools to measure stress in children. CONCLUSIONS: Research addressing stressors and stress in children is limited, and there is wide variation in how researchers define and classify stress in children. Existing measures of stress in children younger than 12 address physiological, psychological, and observational components, but may be inconsistent and threaten validity of otherwise well-designed and well-executed studies. IMPLICATIONS: Improving the understanding and accurate measurement of stress in children enables researchers and clinicians to curtail undesirable health outcomes.

Inclusion of Effect Size Measures and Clinical Relevance in Research Papers.

BACKGROUND: There are multiple issues that arise when researchers focus on and only report "statistical significance" of study findings. An important element that is often not included in reports is a discussion of clinical relevance. OBJECTIVES: The authors address issues related to significance, the use of effect sizes, confidence or credible intervals, and the inclusion of clinical relevance in reports of research findings. METHODS: Measures of magnitude, precision, and relevance such as effect sizes, confidence intervals (CIs), and clinically relevant effects are described in detail. In addition, recommendations for reporting and evaluating effect sizes and CIs are included. Example scenarios are presented to illustrate the interplay of statistical significance and clinical relevance. RESULTS: There are several issues that may arise when significance is the focus of clinical research reporting. One issue is the lack of attention to nonsignificant findings in published works although findings show clinical relevance. Another issue is that significance is interpreted as clinical relevance. As well, clinically relevant results from small-sample studies are often not considered for publication, and thus, findings might not be available for meta-analysis. DISCUSSION: Findings in research reports should address effect sizes and clinical relevance and significance. Failure to publish clinically relevant effects and CIs may preclude the inclusion of clinically relevant studies in systematic reviews and meta-analyses, thereby limiting the advancement of evidence-based practice. Several accessible resources for researchers to generate, report, and evaluate measures of magnitude, precision, and relevance are included in this article.

The perceived reality and environment of the mid-career nurse scientist.

BACKGROUND/PURPOSE: A qualitative study was designed to explore facilitators and barriers to success from the perspectives of self-identified mid-career nurse scientists. METHODS: Data were collected from 84 respondents using open-ended items as part of an electronic survey of self-identified mid-career nurse scientists who were members of regional nursing research societies. DISCUSSION/CONCLUSION: Two main themes emerged: "Perceived Realities" and "What's Needed to Achieve Career Success." Mid-career nurse scientists experience both joy from teaching and research roles and dissatisfaction with research support; difficulty balancing heavy teaching workload, administrative responsibilities, and research, and ineffective mentoring. Based on the challenges in their environment, respondents identified numerous ways to enhance career success including (1) increasing or enhancing release time for research activities, (2) formal infrastructure to support research activities, and (3) targeted, effective mentoring by senior scientists.

Areas of satisfaction and challenges to success of mid-career nurse scientists in academia.

BACKGROUND: Mid-career nurse scientists in academia face many challenges that can lead to burnout and exiting the profession. Finding ways to increase satisfaction and support will help retain these critical faculty in research positions. PURPOSE: Describe areas of satisfaction and challenges to success in the faculty role for mid-career nurse scientists in academia. METHOD: Cross-sectional, descriptive. A total of 65 self-identified mid-career nurse scientists completed an online survey. FINDINGS: Mid-career nurse scientists were most satisfied with their role at their organization, least satisfied with time for research and opportunities to receive mentoring. They felt moderately supported by colleagues and deans, least supported by their ADR. Differences in satisfaction among nurse scientists in different levels of research institutions were noted. DISCUSSION: Challenges to success in mid-career nurse scientists exist. Loss of nurse scientists at mid-career threatens to undermine the knowledge base of the individuals who mentor the next generation of scientists. The discipline must support mid-career scientists in their efforts to be successful in research.

Weight Gain and Blood Pressure in Toddlers Born Very Preterm.

BACKGROUND: Preterm birth is a risk factor for elevated blood pressure in childhood and the development of hypertension and cardiometabolic disease in adulthood; however, mechanisms for the development of both are poorly understood. Rapid weight gain early in childhood may serve as a driver directly and indirectly through cortisol levels found to be elevated in early childhood in individuals born preterm. OBJECTIVES: The objective of this pilot study was to examine the effect sizes of the relationships between weight gain and blood pressure in toddlers born very preterm. A secondary aim was to note any mediating effect of cortisol on the relationships between weight gain and blood pressure. METHODS: A cross-sectional design with a convenience sample of 36 toddlers who were born very preterm was used to examine the relationships between postnatal weight gain, cortisol, and blood pressure at follow-up. RESULTS: Many of the participants experienced rapid weight gain in the first 12 months of life. Mean systolic and diastolic readings were 94 and 56.6, respectively. Diastolic blood pressure readings were obtained from 23 participants, and the majority were elevated. Weight gain was associated with diastolic blood pressure with a medium effect size. A mediating role with cortisol was not supported. DISCUSSION: Although findings need to be validated in a larger sample, the blood pressure elevations in this sample were alarming. If readings continue to amplify as these children age, the fact that elevations are already present during the toddler period could indicate more significant cardiovascular disease in adulthood for this population. Rapid weight gain in early life may be a driver for elevated blood pressure even during early childhood in individuals born preterm.

The Influence of Psychological Stress, Depressive Symptoms, and Cortisol on Body Mass and Central Adiposity in 10- to-12-Year-Old Children.

PURPOSE: The purpose of this study was to examine the influence of psychological stress and depressive symptoms on body mass and central adiposity in 10-to-12-year-old children and to determine the mediating role of cortisol in the relationships among psychological stress, depressive symptoms, body mass, or central adiposity. DESIGN AND METHODS: The convenience sample included 147 children (84 females; 63 males) who were recruited from one middle school and three elementary schools in a rural area of a southeastern state. Height, weight, waist circumference (WC), and salivary cortisol were measured. Children completed the Rating Scale for Pubertal Development for screening, Children's Depression Inventory, and the Feel Bad Scale. Bivariate correlation, multiple regression analyses, and univariate regression techniques were used in data analyses. RESULTS: A positive relationship between psychological stress and depressive symptoms (r = 0.559, p < .001) was found. Depressive symptoms explained a significant amount of the variance in body mass index (BMI) (ß = 0.37, p ≤.001) and central adiposity (ß = 0.40, p ≤ .001) when sex, race/ethnicity, puberty, and socioeconomic status were controlled. No statistically significant relationships were found between psychological stress and cortisol or between depressive symptoms and cortisol. CONCLUSIONS: Depressive symptoms were reported by normoweight, overweight, and obese children. Depressive symptoms accounted for variance in body mass and central adiposity. Practice Implications In addition to regular screening of BMI and WC, nurses and other health care professionals need to consider psychological factors that contribute to childhood obesity.

Recruitment of hard to contact, hard to engage child populations in clinics and schools.

Recruiting children with chronic disease or subgroups of children (low income, obese, specific ages, types of cancer) from clinics and schools for research studies may be particularly difficult. While some have deemed such groups as hard to reach, these groups may be more accurately described as either hard to contact or hard to engage. This is not because children are unknown to the school or clinic but because the researcher's ability to communicate directly with targeted children prior to enrollment is limited. The purpose of this paper is to describe barriers and possible strategies for recruiting hard to contact or hard to engage subgroups of children. Barriers identified in recruiting these children were: naïve to research, communication style and technology, parent/guardian burden, parental conditions and concerns, child stressors and distractions, and research setting. Possible strategies include: pre-consent education, information sheets about study, identifying preferred method of communication, meaningful and appropriate incentives, coordinating recruitment visit with regularly scheduled clinic appointments or school schedule, demonstrating research equipment, informing staff about research study, negotiating creatively for space for research, and emphasizing confidentiality of data. Consideration of barriers to recruitment and utilization of strategies to counteract these barriers is critical to the success of a study involving subgroups of children.

Call to action to support the success of midcareer nurse scientists.

Mid-career nurse scientists in academia are at risk for burnout and departing scientific careers, particularly those in research-intensive academic settings. With the shortage of nursing faculty and the public health need for high-quality nursing research, it is critical to retain current research-focused individuals in nursing. In this paper, we discuss definitions and expectations of mid-career scientists, challenges and barriers faced by mid-career scientists, and opportunities for mid-career scientists, informed by both nursing and non-nursing literature. Finally, we focus on definitions and expectations, challenges, and opportunities specifically related to mid-career nurse scientists in research-intensive academic settings.

Infant Feeding Practices and Weight Gain in Toddlers Born Very Preterm: A Pilot Study.

PURPOSE: Long-term consequences of prematurity are a public health concern. A pattern of slow initial weight gain followed by a period of rapid weight gain has been associated with poor cardiometabolic health outcomes. The purpose of this study was to examine the relationships between infant feeding practices and weight gain in a sample of 18-to-24-month olds corrected age born very preterm. DESIGN AND METHODS: A cross-sectional design was used to examine the relationships between infant feeding practices and weight gain. Estimates of effect sizes and model fit estimates were the primary parameters of interest. RESULTS: Most of the participants received human milk after birth, but most had transitioned to formula before three months. Slightly less than half received complementary foods prior to four months corrected age. Gains in weight and head circumference were rapid after discharge from the neonatal intensive care unit, while gains in length lagged behind. Infant feeding practices did not have a clinically meaningful effect on weight gain. CONCLUSIONS: While the initiation of human milk feedings was encouraging, the duration fell short of recommendations. Practices such as the early introduction of complementary feedings and the addition of rice cereal to the bottle are troubling. Additionally, the rapid increase in weight gain may have a negative impact on future cardiometabolic health. PRACTICE IMPLICATIONS: Clinical recommendations include ensuring support for the use of human milk before and after hospital discharge, close monitoring of physical growth, and ensuring adherence to the guidelines for the introduction of complementary foods.

Child and Maternal Factors That Influence Child Blood Pressure in Preschool Children: An Exploratory Study.

PURPOSE: Hypertension is a risk factor for cardiovascular disease (CVD) in adults and children and has its origins in childhood. While the prevalence of hypertension in children is estimated to be 2 to 5%, instance elevations in blood pressure readings (BPRs) in school-age children and adolescents are more common, track to adulthood, and are an independent risk factor for CVD. Less information is available about BPR in the preschool period and what child factors could influence those BPR. The primary aims of this exploratory study were to determine child blood pressure (BP) levels and determine effect sizes of the relationships between child and maternal factors that can influence child BP. METHODS: A convenience sample of 15 rural and 15 urban children enrolled in Head Start programs (13 males; 14 females; all black) with ability to understand and speak English and with mothers who gave consent and could understand, read and speak English were enrolled. Mothers completed demographic information about their child including, gender, birth history and age. Height, weight, waist circumference and BP were measured in the mothers and the children. Children gave saliva specimens for cortisol and C-reactive protein. RESULTS: Over 37% of the children had elevated BPR with over 20% at or above the 95th percentile. Effect sizes of relationships ranged from very small to large. CONCLUSION: Elevations in BPR may be seen as early as preschool. It is important to examine factors, both child and maternal that influence BP.

Tobacco exposure, weight status, and elevated blood pressure in adolescents.

The pathogenesis of hypertension begins in youth. An estimated 4% of US adolescents have diagnosed hypertension and 17% have elevated blood pressures, predisposing them to hypertension and cardiovascular disease (CVD) later in life. There is limited research on the clustering of CVD risk factors such as tobacco exposure and weight status that may be associated with high blood pressure in adolescents. The aim of this exploratory study was to determine the relationships between total smoke exposure (TSE; cigarette smoking and secondhand smoke), waist circumference, and blood pressure in a sample of rural adolescents, ages 15-18. A convenience sample of 148 adolescents ages 15-18 was recruited from two rural high schools (88 female and 60 male, all Caucasian). Adolescents were assessed for tobacco exposure (self-report, salivary cotinine), weight status (body mass index, waist circumference), and blood pressure. Self-report measures of tobacco exposure included the Uptake Continuum and Peer and Family Smoking measure. Age, gender, waist circumference and salivary cotinine contributed to 35% of the variance in systolic blood pressure and 18% in diastolic blood pressure. One-fourth (25%) of adolescent males and 11% of adolescent females had elevated systolic blood pressures. Approximately one-fifth of the sample (22%) had elevated salivary cotinine levels indicative of tobacco use and secondhand smoke exposure. TSE and waist circumference were predictors of elevated blood pressure in adolescents. Public health measures need to address clusters of risk factors including blood pressure, tobacco exposure, and weight status among adolescents in order to reduce CVD.

Biomarkers of Stress and Inflammation in Children.

Background: Children are increasingly exposed to stressors that can affect their immune function. Given the possible negative effects of stress and inflammation on health, researchers need to use appropriate biomarkers to measure both the effects of stress and subsequent inflammatory responses. Purpose: The purpose of this paper is to briefly review stress and inflammatory pathways, identify biomarkers used to measure chronic stress and chronic inflammation particularly in children in clinical and community settings, and to discuss methodological considerations when measuring stress and inflammation in children. Discussion: Biomarkers of chronic stress can be classified as central, meaning they are made in the brain, or peripheral, meaning they are made in the peripheral tissues in response to central signals. The peripheral biomarker, cortisol, is most frequently used in the community setting. In addition, indirect measures, such as oxytocin, may complement the assessment of stress. Common biomarkers of chronic inflammation in children are C-reactive protein (CRP), TNF-α, and IL-6. Similarly, indirect biomarkers of chronic inflammation, such as IL-2 and IL-1ß, may also be considered. Conclusions: Various types of specimens can be used to measure these biomarkers of stress and inflammation including blood, saliva, urine, sweat, hair, nails, and tears. Each type of specimen has different requirements for collection, storage, and assay. Future research would benefit from standardized biomarker levels across age and development in children and incorporation of other biomarkers.

Strategies to Strengthen Nursing PhD Enrollment: An Ecological Systems Perspective.

BACKGROUND: Nurses with a Doctor of Philosophy (PhD) degree are essential to developing nursing knowledge, promoting health outcomes, and educating the next generation of nurses. Declining enrollment in nursing PhD programs calls for purposeful action. Guided by Bronfenbrenner's Ecological Systems Framework, this article outlines barriers and facilitators, and offers strategies to increase PhD enrollment. METHOD: Extant literature and the authors' cumulative experiences in PhD education and research were reviewed to identify strategies to increase PhD enrollment. RESULTS: Multilevel influences impede or facilitate enrollment in PhD programs. Strategies addressing individual and interpersonal influences included intentional personalized recruiting and early outreach to students at various levels of education. Institutional and organizational strategies included research partnerships and programs, and financial and infrastructure support. Sociocultural strategies included image branding and a positive social media presence supporting nurse scientists. CONCLUSION: Strategies to enhance PhD enrollment across all levels can spark interest in nursing science and PhD enrollment. [J Nurs Educ. 2023;62(12):669-678.].