Susceptibility to stress and nature exposure: Unveiling differential susceptibility to physical environments; a randomized controlled trial.

BACKGROUND: Emerging epidemiological evidence indicates nature exposure could be associated with greater health benefits among groups in lower versus higher socioeconomic positions. One possible mechanism underpinning this evidence is described by our framework: (susceptibility) adults in low socioeconomic positions face higher exposure to persistent psychosocial stressors in early life, inducing a pro-inflammatory phenotype as a lifelong susceptibility to stress; (differential susceptibility) susceptible adults are more sensitive to the health risks of adverse (stress-promoting) environments, but also to the health benefits of protective (stress-buffering) environments. OBJECTIVE: Experimental investigation of a pro-inflammatory phenotype as a mechanism facilitating greater stress recovery from nature exposure. METHODS: We determined differences in stress recovery (via heart rate variability) caused by exposure to a nature or office virtual reality environment (10 min) after an acute stressor among 64 healthy college-age males with varying levels of susceptibility (socioeconomic status, early life stress, and a pro-inflammatory state [inflammatory reactivity and glucocorticoid resistance to an in vitro bacterial challenge]). RESULTS: Findings for inflammatory reactivity and glucocorticoid resistance were modest but consistently trended towards better recovery in the nature condition. Differences in recovery were not observed for socioeconomic status or early life stress. DISCUSSION: Among healthy college-age males, we observed expected trends according to their differential susceptibility when assessed as inflammatory reactivity and glucocorticoid resistance, suggesting these biological correlates of susceptibility could be more proximal indicators than self-reported assessments of socioeconomic status and early life stress. If future research in more diverse populations aligns with these trends, this could support an alternative conceptualization of susceptibility as increased environmental sensitivity, reflecting heightened responses to adverse, but also protective environments. With this knowledge, future investigators could examine how individual differences in environmental sensitivity could provide an opportunity for those who are the most susceptible to experience the greatest health benefits from nature exposure.

An Innovative Educational Intervention for Pediatric Nurse Practitioner Faculty to Meet Social Justice Curriculum Standards.

The association between adverse childhood experiences and negative health outcomes is a public health concern, particularly affecting disadvantaged groups and contributing to health disparities. Pediatric nurse practitioners are well-positioned to address this issue, emphasizing the importance of incorporating social justice concepts into nursing education to develop a pediatric workforce with the necessary skills to curb health disparities. However, evidence-based approaches to incorporating these concepts into pediatric nursing education are limited. To address this gap, we describe an innovative educational intervention that harnesses the power of narratives to empower future pediatric nurse practitioners as champions of social justice and health equity.

Cecostomy tubes improve bowel continence for pediatric patients with spina bifida: A retrospective analysis of outcomes from a single clinic.

PURPOSE: Pediatric patients with spina bifida often experience neurogenic bowel dysfunction. Although cecostomy tubes could improve bowel continence, their effectiveness is not well established in this population. The aims of this study were to better understand the effectiveness of cecostomy tubes relative to other management strategies (between-subject) and to explore their effectiveness among patients who received these placements (within-subject). METHODS: Retrospective analysis of data from pediatric patients enrolled in a national spina bifida patient registry (n = 297) at a single multidisciplinary clinic was performed, covering visits between January 2014 -December 2021. Linear and ordinal mixed effect models (fixed and random effects) tested the influence of cecostomy status (no placement vs placement) and time (visits) on bowel continence while controlling for demographic and condition-specific covariates. RESULTS: Patients with cecostomy tubes had higher bowel continence compared to patients without placements (B = 0.695, 95% CI [0.333, 1.050]; AOR = 2.043, p = .007). Patients with cecostomy tubes had higher bowel continence after their placements compared to before (B = 0.834, 95% CI [0.142, 1.540]; AOR = 3.259, p = 0.011). CONCLUSION: Results indicate cecostomy tubes are effective for improving bowel continence in this pediatric population. Future research is needed to conduct risk analyses and determine the clinical significance of these effects.

Parental Worrying, Family Functioning, and Quality of Life During the COVID-19 Pandemic.

BACKGROUND: The 2019 novel coronavirus pandemic has affected many aspects of American life, with reported increases in parental anxiety and adverse health outcomes among children. However, it is unknown how family functioning and parental anxiety may be associated with child health outcomes during this pandemic. OBJECTIVES: The aim of this study was to explore associations among parental worrying, family functioning, and the health-related quality of life (HRQoL) of middle and high school-aged children in the United States during the 2019 novel coronavirus pandemic. METHODS: Ninety-three parent-child dyads were recruited via snowball sampling through the WhatsApp messenger from December 2020 to February 2021 in this exploratory cross-sectional study. Each family completed a series of self-report measures, including the General Functioning Scale-Family Assessment Device and the Worry Domains Questionnaire for parent respondents and the KIDSCREEN-10 for child respondents. A hierarchical regression analysis was performed to examine effects of parental worrying and family functioning on the HRQoL of middle and high school-aged children. RESULTS: Lower levels of parental worrying and better family functioning predicted better child HRQoL, whereas parental worrying was associated with worse family functioning. The relationship between family functioning and child HRQoL did not differ by levels of parental worrying. Increased child age and parental education were associated with worse child HRQoL. DISCUSSION: The high socioeconomic status sample reported healthy family functioning during the 2019 novel coronavirus pandemic. Family functioning appears to improve child HRQoL consistently, even as parental worrying increases or decreases, although increased worrying would likely decrease family functioning and child HRQoL. The inverse relationships of parental educational attainment with family functioning and child HRQoL are surprising; they may be due to pandemic circumstances and the nature of the sample being high-socioeconomic status families with middle and high school-aged children.

Emerging Frontline Leaders' Voices in Response to COVID-19 Crisis.

BACKGROUND: The COVID-19 pandemic has significantly affected healthcare institutions, introducing new challenges for nurse leaders and their colleagues. However, little is known about how the pandemic has specifically affected the lives of these leaders and what methods and strategies they are using to overcome pandemic-related challenges. OBJECTIVES: The aim of this study was to examine the effect of the 2019 pandemic on emerging healthcare leaders and highlight methods and strategies they used to overcome pandemic-related challenges. METHODS: The participants in this study represent a diverse group of interprofessional healthcare faculty enrolled in a transformational leadership course (Paths to Leadership) when the pandemic first appeared. Three months into the pandemic, the leadership cohort was invited to participate in this qualitative study, exploring four questions: Q1: How have you transformed your working styles in response to the pandemic? Q2: How have you adjusted your personal life in response to the pandemic? Q3: How have you used leadership skills learned from Paths to Leadership during the pandemic? Q4: What lessons have you learned from the pandemic? Participant narratives were analyzed by a team of nurse researchers using conventional qualitative content analysis. RESULTS: Themes for Q1 (working styles) included shifted from face-to-face to telework, faced novel disease and decisions, worked more from home, and challenged to maintain contact with professional peers and team. Themes for Q2 (personal life) included accommodate adults working and children learning from home, looked for and found the positive, and continue to struggle. Themes for Q3 (leadership skills) included reflective practice, listening, holding, and reframing. Finally, themes for Q4 (pandemic lessons) included leadership, human connection, be prepared, taking care of ourselves, and connecting with nature. DISCUSSION: The 2019 pandemic brought hardships and opportunities to faculty members enrolled in an interprofessional transformational leadership course. In conjunction with this course, the pandemic provided a unique opportunity for participants to apply newly acquired relationship building, positive organizational psychology, and reframing skills during a time of crisis. Nursing leaders, whose educational offerings may be immediately "put to the test," may find our lessons learned helpful as they develop strategies to cope with unanticipated future challenges.

Spirituality and Quality of Life among Parents of Adolescents with Spina Bifida.

In this investigational cross-sectional study, we explored the relationships among caregiver burden, depressive symptoms, spirituality, and quality of life (QOL) in 58 parental caregivers of adolescents with spina bifida (SB). A hierarchical linear regression analysis provided evidence that depressive symptoms and caregiver burden were negatively related to QOL scores, but spirituality was positively related. We found a significant interaction between caregiver burden and spirituality, suggesting that spirituality moderates the relationship between caregiver burden and quality of life. The negative effect of caregiver burden on QOL decreased as spirituality increased. These results warrant further research into how caregiver burden and spirituality intersect and impact QOL in parental caregivers of adolescents with SB.

The moderating role of spirituality on quality of life and depression among adolescents with spina bifida.

AIM: To investigate the relationships between spirituality, somatic symptom distress/severity, depressive symptoms and quality of life (QOL) for adolescents diagnosed with spina bifida (SB). DESIGN: Exploratory, cross-sectional design. METHODS: Fifty-eight adolescents with SB in southern California were recruited during routine visits to a multidisciplinary clinic at a healthcare university from January 2016-January 2017. Each adolescent completed a series of self-report measures, including the System of Belief Inventory, Somatic Symptom Scale, Patient Health Questionnaire and Pediatric Quality of Life Inventory. Path analysis was performed to examine regression coefficients for each direct and indirect effect. RESULTS: The mediation-moderation analysis showed that depressive symptoms fully mediated the relationship between symptom distress and QOL (B = 0.029 [0.014], CI [0.007, 0.061]) and higher levels of spirituality moderated the relationship between depressive symptoms and QOL (B = 0.052, p = .018). Spirituality was higher for adolescents with greater symptom severity; including shunt status Welch's F(1, 53.689) = 4.174, p = .046, level of lesion F(2,57) = 3.382, p = .041, and ambulation status F(3, 57) = 2.920, p = .042. CONCLUSION: Adolescents with SB who had greater levels of symptom distress experienced significantly higher levels of depressive symptoms and a lower QOL. Contrary to our expectations, adolescents with greater levels of spirituality had a lower QOL when depressive symptoms were mild/moderate, but no differences were noted when depressive symptoms were severe. IMPACT: This study examined the relationship between spirituality and quality of life (QOL) in adolescents with spina bifida, who were experiencing different levels of depressive symptoms and symptom distress/severity. Depressive symptoms appeared to have a more profound effect on QOL than spirituality. Accordingly, we recommend that healthcare professionals actively screen for depressive symptoms when assessing these adolescents and their physical symptoms/distress levels.