Accuracy study of Angiotensin 1-7 composite index test to predict pulmonary fibrosis and guide treatment.

BACKGROUND: Pulmonary fibrosis can develop after acute respiratory distress syndrome (ARDS). The hypothesis is we are able to measure phenotypes that lie at the origin of ARDS severity and fibrosis development. The aim is an accuracy study of prognostic circulating biomarkers. METHODS: A longitudinal study followed COVID-related ARDS patients with medical imaging, pulmonary function tests and biomarker analysis, generating 444 laboratory data. Comparison to controls used non-parametrical statistics; p < 0·05 was considered significant. Cut-offs were obtained through receiver operating curve. Contingency tables revealed predictive values. Odds ratio was calculated through logistic regression. RESULTS: Angiotensin 1-7 beneath 138 pg/mL defined Angiotensin imbalance phenotype. Hyper-inflammatory phenotype showed a composite index test above 34, based on high Angiotensin 1-7, C-Reactive Protein, Ferritin and Transforming Growth Factor-ß. Analytical study showed conformity to predefined goals. Clinical performance gave a positive predictive value of 95 % (95 % confidence interval, 82 %-99 %), and a negative predictive value of 100 % (95 % confidence interval, 65 %-100 %). Those severe ARDS phenotypes represented 34 (Odds 95 % confidence interval, 3-355) times higher risk for pulmonary fibrosis development (p < 0·001). CONCLUSIONS: Angiotensin 1-7 composite index is an early and objective predictor of ARDS evolving to pulmonary fibrosis. It may guide therapeutic decisions in targeted phenotypes.

Mitochondrial transplantation attenuates lipopolysaccharide-induced acute respiratory distress syndrome.

BACKGROUND: The mitochondria are essential organelles not only providing cellular energy in the form of ATP, but also regulating the inflammatory response and the cell death program. Mitochondrial dysfunction has been associated with various human diseases, including metabolic syndromes as well as inflammatory and neurodegenerative diseases. Acute respiratory distress syndrome (ARDS) is an acute pulmonary disorder characterized by uncontrolled alveolar inflammation, apoptotic lung epithelial/endothelial cells, and pulmonary edema. Despite the high mortality of ARDS, an effective pharmacotherapy to treat this disease has not been established yet. Therefore, identifying a novel targeted therapy for ARDS is important. Recently, exogenous mitochondrial transplantation was reported to be beneficial for treating mitochondrial dysfunction. The current study aimed to investigate the therapeutic effect of mitochondrial transplantation on ARDS in vitro and in vivo. METHODS: Mitochondria were isolated from human stem cells. For in vitro efficacy of mitochondrial transplantation on the inflammation and cell death, murine alveolar macrophages MH-S and human pulmonary microvascular endothelial cells HPMECs were exposed to LPS, respectively. The ARDS mice model established by a single intratracheal instillation of LPS was used for in vivo efficacy of intravenously treated mitochondria. RESULTS: Our results showed that the mitochondria isolated from human stem cells exhibited an anti-inflammatory effect against alveolar macrophages and an anti-apoptotic effect against the alveolar epithelial cells. Furthermore, intravenous mitochondrial treatment was associated with the attenuation of lung injury in the LPS-induced ARDS mice. CONCLUSION: Dual effects of mitochondria on anti-inflammation and anti-apoptosis support the potential of mitochondrial transplantation as a novel therapeutic strategy for ARDS.

Dyadic effects of social support on psychological distress in patients with advanced lung cancer and spousal caregivers: The mediating role of sense of coherence.

OBJECTIVE: The primary objective of this study was to examine the dyadic relationships between perceived social support, sense of coherence (SOC), and psychological distress in advanced lung cancer patients and their spousal caregivers with the dyadic analysis method. METHODS: 302 dyads of patients and their spouses were recruited between April 2023 to October 2023 from a Chinese tertiary hospital. Participants' perceived social support, SOC, and psychological distress were evaluated by corresponding questionnaires. In order to explore the potential dyadic associations between the covariates, the data were analyzed by adopting the actor-partner interdependence mediation model (APIMeM). RESULTS: The findings demonstrated that the impact of perceived social support on psychological distress had both actor and partner effects. Specifically, the perceived social support of patients and their spouses was directly and positively associated with their own psychological distress. Furthermore, in patient-spouse dyads, SOC mediated the actor effects of perceived social support on psychological distress. Another important finding was that perceived social support by spouse had a direct or indirect negative partner effect on the psychological distress of patients. CONCLUSION: The investigation uncovered a dyadic interdependence between perceived social support, psychological distress, and SOC. It is necessary for medical professionals to identify patients and spouses who report poor levels of SOC and perceived social support and implement targeted interventions to address these concerns.

Symptoms, distress, finances, social support, resource utilization, and unmet care needs of patients with gynecological cancer.

PURPOSE: This study explored the unmet care needs of gynecological cancer patients, including overall and subdomain needs (i.e., physical and daily living needs, psychological and emotional needs, care and support needs, and health-system and information needs), and related factors. METHODS: In this cross-sectional study, gynecological cancer patients treated at a medical center in northern Taiwan were recruited. Data on demographics, symptoms, distress, finances, social support, resource utilization, and care needs were collected. Spearman's correlation and the Mann-Whitney U test were used for analysis. RESULTS: This study of 118 cancer patients found that 73% had unmet psychological and emotional needs, followed by 54% with unmet health system and information needs. The most common physical symptoms were insomnia, fatigue, and pain, with 51.7% experiencing moderate or high levels of distress. Overall, the patients received considerable social support, both instrumental and emotional, primarily through medical information booklets (39.0%), cancer information websites (28.8%), and rehabilitative resources (20.3%). Factors associated with unmet care needs included younger age, non-ovarian cancer, symptoms (pain, fatigue, appetite loss, insomnia, dyspnea, nausea, and vomiting), distress, finances, social support, and the use of cancer information websites. CONCLUSION: Psychological and emotional unmet needs is prevalent among patients with gynecological cancer; psychological support is crucial. Younger patients and those with non-ovarian cancer had more unmet care needs. These needs are linked to severe symptoms, distress, financial difficulties, limited social support, and low use of cancer information websites. Enhancing support for this population through targeted interventions is necessary.

Adverse Childhood Experiences Predicting Psychological Distress among Black Youth: Exploring Self-Control as a Moderator.

Contextual risk factors, such as adverse childhood experiences (ACEs), have a significant impact on the mental health of Black youth. Surprisingly, few studies focus efforts specifically on Black youth. The present study investigates the influence of ACEs on psychological distress among Black youth. Additionally, guided by social cognitive theory, this study highlights emotional self-control as a protective mechanism against the negative consequences of ACEs. Our findings show that ACEs (T1) predicted psychological distress among Black youth a year later (T2). Emotional self-control emerged as a significant buffer of ACEs on the association with psychological distress. Thus, to prevent negative mental health outcomes for Black youth, it is imperative to focus prevention efforts on the crucial risk factors that affect healthy development. By working to increase emotional self-control among Black youth who suffered adverse childhood experiences, negative mental health outcomes over time can be reduced.

Risk factors for acute respiratory distress syndrome in sepsis patients: A meta-analysis.

Background: Acute Respiratory Distress Syndrome (ARDS) is a critical complication of sepsis, associated with high morbidity and mortality. Identifying risk factors for ARDS among sepsis patients is essential for early intervention and improving outcomes. Methods: We conducted a comprehensive meta-analysis, reviewing studies that examined the association between various risk factors and ARDS development in sepsis patients. Databases such as PubMed, EMBASE, Cochrane Library, Medline, CINAHL, and Web of Science were searched up to January 2024, without language restrictions. Eligible studies included observational cohorts and case-control studies. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were calculated using a random-effects model. Heterogeneity was assessed through I2 statistics, and publication bias was evaluated via the Luis Furuya-Kanamori (LFK) index. Results: 15 studies with more than 40,000 participants were analyzed. Significant risk factors for ARDS included pulmonary infection (OR: 2.696, 95 % CI: 1.655 to 4.390), septic shock (OR: 2.627, 95 % CI: 1.850 to 3.731), and pancreatitis (OR: 3.734, 95 % CI: 2.958 to 4.712). No significant associations were found between the development of ARDS in septic patients and the following risk factors: sex (OR: 1.106, 95%CI: 0.957-1.279), smoking status (OR: 1.214, 95%CI: 0.835-1.765), or steroid use (OR: 0.901, 95%CI: 0.617-1.314). APACHE-II and SOFA scores were predictive of ARDS development, emphasizing their utility in clinical assessments. Conclusion: Pulmonary infection, septic shock, and pancreatitis significantly increase ARDS risk in sepsis patients. Our findings advocate for targeted management of these risk factors to mitigate ARDS development, emphasizing the importance of personalized care in sepsis management.

Psychological distress and coping skills used by individuals in the crisis caused by the COVID-19 pandemic.

BACKGROUND: Psychological distress, as a key indicator, describes a person's emotional problems and psychological reactions to adapt to the environment. This study aimed to investigate the relationship between psychological distress and coping strategies used by individuals during the crisis caused by COVID-19. MATERIALS AND METHODS: The current research is an analytical cross-sectional study that was designed in 2021. The sampling area included the three cities of Lar, Gerash, and Evaz in the south of Fars province in the south of Iran. The study population was the residents of these three cities during the COVID-19 pandemic. The final sample size in the present study was 384 people. Individuals were selected through available sampling. By answering questions from the self-assessment system of COVID-19 disease, the Ministry of Health and Medical Education filled out the necessary information for individual screening and registration of the symptoms of COVID-19 disease. Then, they completed the Coping Methods Questionnaire and the Psychological Distress Questionnaire. RESULTS: The mean age of the participants was 40.90 years. One hundred sixty-seven (43.5%) participants were male, and 217 (56.5%) were female. The mean score of problem-oriented coping style was significantly different between the levels of education (P = 0.001). The mean score of problem-solving coping style for the participants suspected of being infected with COVID-19 was 6.18 scores lower than others, and the difference was statistically significant (P = 0.001). Multiple regression with a forward selection also showed that among the studied variables, age, problem-oriented, and emotion-oriented coping strategies were important variables affecting mental distress. CONCLUSION: People who were not suspected of having COVID-19 symptoms had a higher mean problem-oriented coping score than those who were suspected of having COVID-19. Therefore, early identification of suspects and the implementation of counseling and training programs can be very effective.

Weight bias internalization and its association with psychological distress and weight-related factors among youths in university, Thailand.

BACKGROUND: Weight bias internalization (WBI) is associated with poor weight-related health and psychological health problems in adults. However, less is known about WBI in Thai youths, and its associated factors are scarce. This study aimed to assess the association between psychological, weight-related factors, and WBI among Thai youths. MATERIALS AND METHODS: A cross-sectional design was conducted on 1185 university youths from three universities in northeastern, Thailand from January to June 2023, with multistage sampling methods. The data were collected by self-administered questionnaire. Multinomial logistic regression was applied to explore factors that influence WBI. RESULTS: Most of the youth were female; with the average body mass index (BMI) was 23.3 ± 3.2 kg/m2. More than half (n = 628; 52.9%) of them reported a high level of WBI that was present across the weight spectrum. Approximately 41.4% (n = 490) reported being dissatisfied with their body image, and 50.6% (n = 600) had peers with obesity. WBI was positively related to depressive symptoms, perceived stress, the experience of weight stigma, BMI, and body image dissatisfaction. Conversely, it was negatively related to self-esteem and peers with obesity. CONCLUSION: WBI is influenced by several psychological and weight-related factors. Additionally, youths across body weight categories could be vulnerable to high WBI. Hence, consideration of these potential factors could be useful in designing targeted interventions to reduce WBI.

Glucocorticoid therapy for acute respiratory distress syndrome: Current concepts.

Acute respiratory distress syndrome (ARDS), a fatal critical disease, is induced by various insults. ARDS represents a major global public health burden, and the management of ARDS continues to challenge healthcare systems globally, especially during the pandemic of the coronavirus disease 2019 (COVID-19). There remains no confirmed specific pharmacotherapy for ARDS, despite advances in understanding its pathophysiology. Debate continues about the potential role of glucocorticoids (GCs) as a promising ARDS clinical therapy. Questions regarding GC agent, dose, and duration in patients with ARDS need to be answered, because of substantial variations in GC administration regimens across studies. ARDS heterogeneity likely affects the therapeutic actions of exogenous GCs. This review includes progress in determining the GC mechanisms of action and clinical applications in ARDS, especially during the COVID-19 pandemic.

Physical Rehabilitation Using Oromotor Stimulation, Manual Airway Clearance Technique, Positioning, and Tactile and Kinaesthetic Stimulation (PROMPT) Protocol in Low-Birth-Weight Triplets With Neonatal Respiratory Distress: A Case Series.

Neonatal respiratory distress syndrome (RDS), a severe respiratory illness that is likely to affect preterm newborns especially those who were born preterm with low birth weight (LBW) or multiple births, is one of the complications that preterm babies are likely to develop. Physical Rehabilitation using Oromotor Stimulation, Manual Airway Clearance Technique, Positioning, and Tactile and Kinaesthetic Stimulations (PROMPT) is the intervention followed in this study to determine its effectiveness in the treatment of RDS in LBW triplets. The PROMPT protocol involves interventions such as manually promoting the airway, positioning, oral motor stimulation, and tactile and kinesthetic stimulation. The study examined triplets of similar weight, 1.23g, 1.36g, and 1.18g, at birth. Thus, all known triplets were suffering from the symptoms of RDS like fast breathing and grunting. They were born via premature delivery at 30+5 weeks of pregnancy. Chest X-rays were used as a diagnostic tool for assessing RDS. At the same time, the PROMPT protocol was administered and significant improvements were seen in respiratory health and there was reduced use of mechanical ventilation. The PROMPT protocol shows how effectively an organized method can be applied to treat RDS in LBW triplets.

The Role of Online Well-Being Therapy in Overcoming Allostatic Overload in Medical Workers: A Pilot Randomized Controlled Study.

INTRODUCTION: Stress may lead to allostatic overload. Well-being therapy (WBT) might mitigate it by enhancing psychological well-being and protecting from psychological symptoms. Since no reports are available on the use of WBT in allostatic overload, we evaluated online WBT effects in reducing allostatic overload in medical workers during the coronavirus pandemic. METHODS: Sixty-six participants with allostatic overload were enrolled and randomly assigned to eight sessions of online WBT (n = 32) or eight sessions of an online psychoeducation program on healthy lifestyle (CON) (n = 34). The primary outcome was the prevalence rate of allostatic overload in the two groups at session 8 (T2). Secondary analyses were performed on changes in the PsychoSocial Index (PSI) and Psychological Well-Being (PWB) scales scores at the same time points. Generalized estimating equation models were employed. RESULTS: The WBT group showed a significantly lower rate of allostatic overload at T2 than the CON group (28.13% vs. 70.59%, p < 0.001); similar results were found at T1, T3, and T4 (p < 0.001). Compared to CON, WBT produced a significant decrease in psychological distress (p < 0.001) and abnormal illness behavior (p = 0.031), as well as a significant improvement in PWB autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance (p < 0.001). CONCLUSION: Online WBT may be an effective non-pharmacological therapeutic strategy for individuals with allostatic overload. These findings need to be further validated in different clinical populations.

A Critical Review on Pargament's Theory of Religious Coping: In the Context of the COVID-19 Pandemic.

Religious coping has a constant association with mental health when dealing with distressing events in life. In this case, the religious coping theory of Pargament can be a theoretical model for mental health during the COVID-19 pandemic. This article aims to investigate how positive religious coping can help us to overcome a negative life event. This theoretical study tried to find positive models of religious coping approaches, develop a concise measurement of these religious coping approaches, and investigate their effects on mental health in difficult situations. We reviewed the psychological impact of the pandemic, specifically negative psychological effects, e.g., fear of getting sick, anxiety, and distress. The article presents an effectual, theoretically suggestive way to assimilate religious aspects into patterns and studies of coping, stressors, and mental health. This paper argues that religious coping can help us to overcome mental stress during a difficult situation.

Early-onset renal dysfunction in Jeune syndrome: A case report with atypical presentation.

Jeune syndrome, a rare autosomal recessive disorder, is characterized by skeletal abnormalities, particularly a narrow, bell-shaped chest, leading to severe respiratory distress in newborns. This case report details a full-term female neonate presenting with significant respiratory challenges, typical skeletal features, and early-onset renal dysfunction. Despite normal initial imaging, persistent renal abnormalities were observed, underscoring the need for early diagnosis, vigilant monitoring, and a multidisciplinary management approach to optimize outcomes for patients with Jeune syndrome.

Perspectives on Self-Management and Meditation: A Qualitative Study of Adolescents With Type 1 Diabetes Mellitus and Their Parents.

BACKGROUND: One in three adolescents with type 1 diabetes mellitus (T1DM) experiences diabetes distress, which predicts poor self-management and glycemic control. Mindfulness-based interventions such as meditation have been associated with reduced psychological distress and health outcomes in different populations. This study explores the psychosocial barriers and facilitators of diabetes self-management and beliefs about meditation practices. METHODS: Eight adolescents aged 15-19 who had been diagnosed with T1DM for more than a year were invited to participate in a 40-60-minute semi-structured one-on-one interview. Their parents were also invited to participate in the study. Three of the eight parents invited were able to participate in the study. Participants were asked about perceived psychosocial barriers and facilitators of diabetes self-management and their beliefs about meditation as a tool for addressing some of the psychosocial barriers to self-management. Data were analyzed using NVivo 10 (QSR International, Melbourne, Australia). Conventional content analysis was conducted based on an inductive coding approach. RESULTS: Adolescents with T1DM had similar psychosocial challenges with managing T1DM, including high levels of diabetes distress and forgetfulness due to competing demands on their time. They also noted similar facilitators to effective self-management, such as the presence of family and peer support. Acceptance of T1DM diagnosis and personal commitment to self-management were also indicated as common facilitators of self-management. Adolescents with T1DM and parents of adolescents with T1DM believe that meditation can play a positive role in T1DM self-management by reducing diabetes distress and improving mental health and overall well-being. CONCLUSION: Results suggest that adolescents with T1DM and parents of adolescents with T1DM believe peer and family support is crucial to diabetes self-management. They also noted that diabetes distress and forgetfulness are primary barriers to self-management. Participants also see a potential for meditation to help manage general stress and diabetes distress, thereby aiding self-management. Further research is needed to explore meditation-based interventions to reduce diabetes distress in adolescents diagnosed with T1DM. The findings from this study can inform the development and implementation of meditation-based interventions that integrate family and peer support to reduce diabetes distress and enhance self-management in adolescents with T1DM.

Beyond presence of symptoms: Self-reported psychosocial distress interference among outpatient youth with cancer and other life-limiting conditions.

BACKGROUND: Youth with life-limiting conditions face significant psychosocial challenges (e.g., symptoms of anxiety, depression, and pain) throughout illness and treatment. Without appropriate intervention, this can negatively affect long-term outcomes (e.g., disease management, health-related quality of life). Prompt identification and appropriate attention to distress can mitigate these effects. We aimed to determine the prevalence and severity of distress interference among outpatient youth with cancer and other life-limiting conditions, using the Checking IN screener. PROCEDURE: Within a larger study across four hospital centers, English-speaking pediatric outpatients aged 8-21, and a caregiver-proxy-reporter, completed a brief distress screener. Descriptive analyses were used to characterize the sample and evaluate reported distress symptoms. RESULTS: Checking IN was completed by 100 participants, aged 8-21 (M = 14.27, SD = 3.81); caregivers completed an equivalent proxy screener. Youth most frequently endorsed fatigue (moderate: n = 50, 50.0%; high: n = 21, 21.0%), paying attention (moderate: n = 45, 45.0%; high: n = 16, 16.0%), and sleep difficulty (moderate: n = 46, 46.0%; high: n = 13; 13.0%) as problematic. Caregivers proxy reported fatigue (moderate: n = 46, 46.0%; high: n = 32, 32.0%), worry (moderate: n = 56, 56.0%; high: n = 10, 10.0%), and sleep difficulty (moderate: n = 47, 47.0%; high: n = 14; 14.0%) as most problematic. Group differences between youth and caregiver responses were not significant. CONCLUSIONS: Youth self-report via Checking IN can detect psychosocial distress interference. By directing resources based on real-time assessment of symptom interference, there is potential to simplify outpatient psychosocial screening and improve referral timeliness and specificity, thus allowing for more effective attention to evolving symptoms of distress.

Self-compassion and death distress among individuals affected by the February 6, 2023, Türkiye Earthquake: The mediating role of doomscrolling and resilience.

Large-scale events like natural disasters and epidemics can have significant impacts on individuals' mental health worldwide. Thus, it is crucial to examine the psychological effects of such events on people. This study aimed to investigate the relationship between self-compassion, death distress, doomscrolling, and resilience, among individuals affected by earthquakes. A total of 364 Turkish adults affected by the earthquakes that occurred in Türkiye on February 6, 2023, participated in the study. Structural equation modeling was utilized to explore the mediating roles of doomscrolling and resilience in the association between self-compassion and death distress. The results of the structural equation modeling indicated that both doomscrolling and resilience mediated the relationship between self-compassion and death distress in earthquake-affected individuals. These findings contribute to understanding the interplay between self-compassion, death distress, doomscrolling, and resilience in the context of earthquakes and are expected to inform future research endeavors.

Symptom clusters of patients with advanced thyroid cancer: a cross-sectional study.

PURPOSE: To investigate and analyze the symptom clusters of patients with advanced thyroid cancer and provide a basis for developing targeted symptom management measures. METHODS: Patients who visited a multidisciplinary outpatient service for advanced thyroid cancer at a tertiary A hospital in Sichuan Province from April 2022 to April 2023 were selected using convenience sampling. A cross-sectional survey was conducted using the M.D. Anderson Symptom Inventory-Thyroid Cancer module (MDASI-THY). Symptom clusters were extracted by exploratory factor analysis. RESULTS: Disturbed sleep had the highest incidence (75.7%) and severity (3.0 points), while mood distress had the highest incidence (63.5%) and severity (2.0 points) of symptom interference. Three symptom clusters were identified: mood-fatigue-sleep, digestive tract-sensation, and thyroid cancer-specific symptom clusters. CONCLUSION: Patients with advanced thyroid cancer have multiple symptom clusters that seriously affect their daily lives. Health care professionals should conduct targeted observation and preventive treatment to reduce the burden of symptoms on patients.

Virtual Reality-Based Psychoeducation for Dementia Caregivers: The Link between Caregivers' Characteristics and Their Sense of Presence.

In neuropsychology and clinical psychology, the efficacy of virtual reality (VR) experiences for knowledge acquisition and the potential for modifying conduct are well documented. Consequently, the scope of VR experiences for educational purposes has expanded in the health field in recent years. In this study, we sought to assess the effectiveness of ViveDe in a psychoeducational caregiver program. ViveDe is a VR application that presents users with possible daily life situations from the perspective of individuals with dementia. These situations can be experienced in immersive mode through 360° video. This research aimed to ascertain the associations between the sense of presence that can be achieved in VR and some users' psychological characteristics, such as distress and empathetic disposition. The study involved 36 informal caregivers of individuals with Alzheimer's disease. These participants were assessed using scales of anxiety and depression, perceived stress, empathy, and emotional regulation. They were asked to participate in a six-session psychoeducation program conducted online on dementia topics, in addition to experiencing the ViveDe application. The immersive VR sessions enabled the caregivers to directly experience the symptoms of dementia (e.g., spatial disorientation, agnosia, difficulty in problem-solving, and anomia) in everyday and social settings. The results indicated that although the experience in ViveDe (evaluated using the XRPS scale and five questions about emotional attunement) showed efficacy in producing a sense of first-person participation in the symptoms of dementia, further research is needed to confirm this. The structural equation model provided evidence that the characteristics of individuals who enjoy the VR experience play a determining role in the perceived sense of presence, which in turn affects the efficacy of the VR experience as a psychoeducational tool. Further research will be conducted to ascertain the potential role of these elements in conveying change in the caregivers of people with dementia. This will help us study the long-term effectiveness of a large-scale psychoeducation program in VR.

A Longitudinal Study of Cultural Consonance, Personal Agency, and Psychological Distress in Urban Brazil.

The relationship between culture, as a set of norms that structure human social practice, and agency, as the human capacity to act, has been debated for decades. Achieving clarity in how these constructs intersect has been hampered by difficulty in measuring either one, and theory has not suggested how a model linking culture and agency might be specified. We present a model in which culture is measured as cultural consonance, or the degree to which individuals actually incorporate prototypes for behavior encoded in cultural models into their own behavior. This measurement is then integrated with a measure of individuals' sense of personal agency. In a previous study in urban Brazil, we found that personal agency was associated with higher cultural consonance, which in turn was associated with lower psychological distress; however, those data were from a cross-sectional survey, thus limiting the causal inference. Here we present the results of a follow-up study in which a subset of respondents was re-interviewed on average four years later. These data are consistent with a model in which cultural consonance is the proximate causal influence on psychological distress, while personal agency is a distal or exogenous influence. The implications of these results for the relative roles of culture and agency as influences on subjective well-being are discussed.

Building Social Support and Moral Healing on Nursing Units: Design and Implementation of a Culture Change Intervention.

The healthcare industry continues to experience high rates of burnout, turnover, and staffing shortages that erode quality care. Interventions that are feasible, engaging, and impactful are needed to improve cultures of support and mitigate harm from exposure to morally injurious events. This quality improvement project encompassed the methodical building, implementation, and testing of RECONN (Reflection and Connection), an organizational intervention designed by an interdisciplinary team to mitigate the impact of moral injury and to increase social support among nurses. This quality improvement project was conducted in a medical intensive care unit (MICU) in a rural, academic medical center. We employed an Evidence-Based Quality Improvement (EBQI) approach to design and implement the RECONN intervention while assessing the feasibility, acceptability, and preliminary effectiveness via surveys (n = 17). RECONN was found acceptable and appropriate by 70% of nurses who responded to surveys. Preliminary effectiveness data showed small to moderate effect sizes for improving social support, moral injury, loneliness, and emotional recovery. Further evaluation is warranted to establish the effectiveness and generalizability of RECONN to other healthcare settings.