Relationship between Transition Shock, Professional Stressors, and Intent to Leave the Nursing Profession during the COVID-19 Pandemic.

Background and Objectives: Moving nurses to a COVID-19 department may cause the phenomenon of transition shock, which occurs when already employed nurses change jobs. A set of confusing and uncertain feelings arise due to the unfamiliar work environment, which may lead to their intention to leave the nursing profession. The aim of this study was to examine transition shock and the contribution of both the respondents' characteristics and the presence of stressors to the occurrence of transition shock in nurses assigned to work in COVID-19 departments. Materials and Methods: A cross-sectional study with 120 nurses employed in COVID-19 departments was conducted. Several linear regression models were used to assess the association between transition shock, personal and professional COVID-19 stressors, and the intention to leave the nursing profession. Results: Nurses who intended to leave the profession showed higher transition shock and higher personal and professional stressors (p < 0.001). Female nurses had lower transition shock (ß = -0.16; p = 0.036) and higher personal COVID-19 stressors (ß = 0.27; p < 0.001). University education contributes to the lowering of nurses' transition shock (ß = -0.16; p = 0.038). Nurses who did not intend to leave the nursing profession had lower personal COVID-19 stressors (ß = -0.15; p = 0.044). Transition shock was associated with personal COVID-19 stressors (ß = 0.39; p < 0.001) and professional COVID-19 stressors (ß = 0.29; p < 0.001), and vice versa. Conclusions: The phenomenon of transition shock was present after nurses transitioned to working in COVID-19 departments. Transition shock may cause more nurses to leave the profession, which may have a strong impact on the health system in many countries that are already facing a shortage of nurses. Additional education on and preparation for adapting to new working conditions with psychological support could have an influence by lowering the level of nurses' transition shock.

Religiousness, Anxiety and Depression in Patients with Glaucoma, Age-Related Macular Degeneration and Diabetic Retinopathy.

BACKGROUND: Many chronic medical conditions such as glaucoma, senile macular degeneration and diabetic retinopathy are further complicated by emotional and psychological disorders. Religiousness represents a part of a social culture and has a significant role in the prevention of mental difficulties of the patients, especially those belonging to older population. The aim of this study was to investigate the connection between religiousness, anxiety, and depression in patients with glaucoma, age-related macular degeneration and diabetic retinopathy and to test their connection related to different diagnosis. SUBJECTS AND METHODS: This cross-sectional study included 163 patients divided into three groups (glaucoma group, senile macular degeneration group and diabetic retinopathy group). Respondents voluntarily agreed to participate in the study and with assistance they fully completed the Scale of Religiousness, Hospital Anxiety and Depression Scale, General Health Questionnaire and demographic information (age, gender, education, employment and marital status). RESULTS: The results showed noticeable religiosity of the respondents (M=18.31, SD=5.28), but also the presence of anxiety (M=7.55, SD=3.73), especially in patients with glaucoma, as well as impaired mental health in AMD patients (M=19.56, SD=4.14). No differences were found in the severity of anxiety, depression, general health and religiosity between groups, but the presence of depression in subjects with age-related macular degeneration significantly affects the level of religiosity (p=0.032). CONCLUSION: These results unequivocally point to the need for further research and raising awareness of all health professionals about the importance of a holistic approach to the patient regardless of his diagnosis in order to identify the possible effective ways to deal with chronic disease considering all levels of patient's needs.

Sleep Quality and Evening Salivary Cortisol Levels in Association with the Psychological Resources of Parents of Children with Developmental Disorders and Type 1 Diabetes.

BACKGROUND: Sleep deprivation can decrease parental well-being and degrade mental and physical health in parents of children with chronic illness. The aim of this study was to explore the associations of sleep quality, psychological stress perception, and evening salivary cortisol concentration with self-esteem, optimism and happiness in parents of children with type 1 diabetes and developmental disorders compared to parents of healthy, typically developing children. METHODS: We studied 196 parents of children with chronic conditions, including autistic spectrum disorder (N = 33), cerebral palsy (N = 18), Down syndrome (N = 33), and diabetes mellitus type 1 (N = 40) and parents of healthy children (N = 72). We evaluated parental sleep quality, evening salivary cortisol levels, self-esteem, optimism and happiness. Multiple linear regression models were used to assess associations between variables. RESULTS: Compared with those of the control group, the parents of children with autistic spectrum disorders had higher evening cortisol concentrations (ß = 0.17; p = 0.038) and lower perceptions of happiness (ß=-0.17; p = 0.017), while parents of children with type 1 diabetes had disrupted sleep quality (ß = 0.25; p = 0.003). Optimism was negatively associated with the evening cortisol concentration (ß=-0.18; p = 0.023) and sleep quality index (ß=-0.20; p = 0.012). CONCLUSIONS: Public health programs aimed at lifestyle habit improvement, respite care, and relaxation for parents of children with chronic conditions would be useful for improving parental sleep quality, self-esteem, optimism and happiness.

Are They the Same for All People? Nurses' Knowledge about the Basic Human Needs of People with Disabilities.

Nursing care involves a continuous interaction between nurses and people with disabilities. This has created a need for assessment tools that measure nurses' knowledge about the basic human needs of people with disabilities. The aim of this cross-sectional study was to develop a Knowledge of Basic Human Needs Scale and investigate nurses' levels of knowledge about the basic human needs of people with disabilities and their association with nurses' education. Data were analyzed using principal component analysis to test the construct validity and to identify factors using principal varimax rotation. The reliability estimate was based on Cronbach's alpha coefficient. Linear regression models were used to assess the association between knowledge about basic human needs and predictors. Factor analysis extracted eight factors, explaining 66.3% of the total variance. The sampling adequacy, criterion validity, and internal consistency were satisfactory. The nurses' levels of education was associated with their knowledge about the basic human needs of people with disabilities. The questionnaire constitutes a valuable contribution to improving nurses' knowledge and practice, as well as the quality of healthcare, and it provides a contribution to improving the quality of life for people with disabilities.

Emotions and Food Consumption: Emotional Eating Behavior in a European Population.

Emotion can reflect in the perception of food consumption. An increase in food intake during emotional and psychological conditions may have a negative impact on human health. The aim of this cross-sectional study was to determine the associations between food consumption, emotional eating behavior, and emotional conditions such as stress, depression, loneliness, boredom eating, maintaining vigilance and alertness, and emotional food consolation. We used a Motivations for Food Choices Questionnaire (Eating Motivations, EATMOT) to determine the emotional aspects of food consumption in 9052 respondents living in 12 European countries between October 2017 and March 2018. Ordinal linear regression was used to identify the associations between the emotional eating behavior and emotional conditions such as stress, depression, loneliness, emotional consolation, and reasons to improve physical and psychological conditions. The regression models confirmed the associations between food consumption, emotional conditions, and emotional eating behavior. Associations were found between the emotional eating behavior and stress (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.07-1.60, p = 0.010), depressive mood (OR = 1.41, 95% CI = 1.40-1.43, p < 0.001), loneliness (OR = 1.60, 95% CI = 1.58-1.62, p < 0.001), boredom (OR = 1.37, 95% CI = 1.36-1.39, p < 0.001), and emotional consolation (OR = 1.55, 95% CI = 1.54-1.57, p < 0.001). Emotional eating was associated with an effort to improve physical and psychological conditions, such as controlling body weight (OR = 1.11, 95% CI = 1.10-1.12, p < 0.001), keeping awake and alert (OR = 1.19, 95% CI = 1.19-1.20, p < 0.001) and consumption to feel good (OR = 1.22, 95% CI = 1.21-1.22, p < 0.001). In conclusion, emotions might provoke emotional eating behavior. The appropriate way to handle stress, depression, or other emotional states is important in conditions of being emotionally overwhelmed. The public should be educated on how to handle different emotional states. The focus should be moved somehow from emotional eating and the consumption of unhealthy food to healthy lifestyle practices, including regular exercise and healthy eating habits. Thus, it is necessary to halt these negative health effects on human health through public health programs.

Family and Individual Quality of Life in Parents of Children with Developmental Disorders and Diabetes Type 1.

BACKGROUND: This cross-sectional study assessed both family and individual quality of life (QOL), and their association with self-esteem, optimism, chronic psychological stress, anxiety, and depression in parents of children with chronic conditions. METHODS: Parents of children with Down syndrome (DS), autistic spectrum disorder (ASD), cerebral palsy (CP), diabetes mellitus type 1 (DMT1), and parents of children without chronic diseases with typical development (TD) were included. Multivariate linear regression analysis was used to assess parental characteristics associated with the domains of individual and family QOL. RESULTS: Compared to the parents of TD children, parents of children with ASD and DS were more likely to report reduced family QOL in all domains, while parents of children with DMT1 had lower parental perception. Self-esteem was positively associated with all domains of individual QOL, while optimism was associated with the overall individual QOL perception and health. Higher stress perception was negatively associated with most of the domains of individual and family QOL. CONCLUSIONS: This study confirmed that parents of children with chronic conditions are more likely to have lower perception of both individual and family QOL, which were associated with self-esteem, chronic stress, anxiety, and depression. Interventions should focus not only on the child with a chronic condition but on parents too.

Is Better Knowledge about Health Benefits of Dietary Fiber Related to Food Labels Reading Habits? A Croatian Overview.

The aim of this cross-sectional study was to determine the associations between health dietary patterns, knowledge, and consumption of dietary fiber (DF) with frequency of food label reading on food products with special reference to DF. The study was conducted in 2536 Croatian adults using an original questionnaire. Multiple linear regression models were used to assess associations between food label reading habits and predictor variables. Our study confirms the association between habits regarding the reading of labels on food products, especially in relation to information about DF with the sociodemographic factors of respondents, dietary food patterns and DF consumption, as well as knowledge and sources of information about DF. Women, individuals with a university-level education, and those living in an urban environment had more frequent labels used. Food habits as well as eating outside of the home were positive predictors while eating fast food was a negative predictor of food label reading. Knowledge about DF, especially about its health benefits, was also associated with food label reading. The interpretation of associations could help with the design of effective public health programs. Targeted education campaigns to educate and sensitize the population about food labeling and monitoring may improve general knowledge about healthy food and its benefits, which include indirect effects on the prevention of non-communicable chronic diseases.

Self-Esteem, Anxiety, and Depression in Older People in Nursing Homes.

BACKGROUND: Social environment and type of care may influence mental health in late life. The aim of this study was to assess the associations between depression, anxiety, and self-esteem in older people. METHODS: The study evaluated mental health in people older than 65 years of age in Zadar County, Croatia. The participants were interviewed using the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the Rosenberg Self-Esteem Scale. Multiple linear regressions were used to assess the correlations between depression, anxiety, and self-esteem. RESULTS: Compared with elderly people living in their own homes, elderly people in nursing homes reported lower self-esteem, higher depression, and higher anxiety. The level of self-esteem decreased with increased levels of depression. Anxiety was significantly associated with depression, while depression strongly increased with an increase in anxiety. Older age was associated with depression, while widowhood was a negative predictor of self-esteem. Institutionalization was borderline significantly associated with anxiety, while gender was associated with anxiety. CONCLUSIONS: The study found associations between self-esteem, anxiety, and depression in the elderly. The strategy of humanization in nursing care for older people should be applied equally in nursing homes and in community-dwelling states. Public health programs aimed at maintaining the mental health of older people are needed.

Awakening cortisol indicators, advanced glycation end products, stress perception, depression and anxiety in parents of children with chronic conditions.

This cross-sectional study aims to investigate awakening cortisol indicators and to explore their association with stress perception, advanced glycation end products (AGEs), depression and anxiety in parents of children with chronic conditions. We included five parental groups according to children's diagnoses: Down syndrome (DS; N = 31), autistic spectrum disorder (ASD; N = 29), cerebral palsy (CP; N = 15), diabetes mellitus type 1 (DMT1; N = 38), and a control group of heathy children (CG; N = 33). Salivary cortisol and AGEs were measured, alongside with psychological indices. Partial correlation and multiple linear regression were used in the analysis to identify parental characteristics associated with total awakening cortisol output (area under the curve with respect to the ground, AUCG), cortisol awakening response (area under the curve with respect to the increase, AUCI), perceived stress, and health outcomes (AGEs, depression and anxiety). There was no difference between groups for AUCG, while DS and DMT1 groups showed reduced AUCI (ß = -0.241, p = 0.040; ß = -0.249, p = 0.028, respectively), and ASD parents had a borderline insignificant result (ß = -0.205, p = 0.081). Non-smokers had higher AUCG, and parental sedentary activity and sleep duration were associated with AUCI. AUCG was positively associated with AGEs (ß = 0.218, p = 0.013), anxiety (ß = 0.207, p = 0.004), and with depression (ß = 0.156, p = 0.034), unlike the AUCI. DS parental group showed lower general stress perception (ß = -0.260, p = 0.005). Parents of children with DMT1 had more pronounced depressive symptoms (ß = 0.183, p = 0.039), while CP parents had a borderline insignificant result for depression (ß = 0.143, p = 0.058). Based on these results, parents of children with chronic conditions have altered awaking cortisol response and are under increased risk of adverse health consequences.

Contribution of fruit, vegetables, whole cereals, and legumes to total fibre intake in adult Croatian Dalmatian population.

There is compelling evidence that fruit, vegetables, whole cereals, and legumes make about 80 % of the total food fibre intake and have a potential to help in the prevention of a number of diseases. The aim of our study was to estimate total fibre intake from consumption of this fibre-rich food, partly reported in our earlier study in Croatian adult population. Current data analysis involved a non-probabilistic sample of 1,034 adult participants from Dalmatia, Croatia who responded to a validated food frequency questionnaire between October 2014 and March 2015. We also analysed the sales data obtained from three shopping centres in the Zadar area (Croatian coast) to establish a list of most frequently bought fruit, vegetables, whole cereals, and legumes and to calculate dietary fibre (DF) intake for each of the top-selling items and conversion factors for each food group. We then used these conversion factors to calculate individual total fibre intake (TFI) in our population. It was 11.4 g per person per day, which is less than half the recommended dietary requirements. On average, respondents reported to consume one piece of fruit and one meal of vegetables a day, which is less than half the daily recommendation for either. 25.8 % of respondents reported no consumption of whole cereals at all, and only 0.2 % of the population consumed the recommended 3-5 servings of whole grains or legumes a day. We also observed significantly higher consumption of fruit and whole grains/legumes in women than men. Our findings alert to poor dietary fibre intake in Croatian adult population, which is similar to other western countries and points to issues deeply rooted in these economies. However, our findings may be either an over- or under-estimation and need to be verified through longitudinal research on a wider sample using more precise tools.

The Eating Motivations Scale (EATMOT): Development and Validation by Means of Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM).

INTRODUCTION: The objective was to develop and validate an instrument that measures different determinants of people's food choices and simultaneously accounts for a variety of factors: health, emotions, price and availability, society and culture, environment and politics, and marketing and advertising. METHODS: This is a cross-sectional study focusing on food choice determinants. It was carried out in 16 countries in 2017 and 2018. This study included 11,960 volunteer adult participants from different countries. The data was validated using Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM). RESULTS: Validation using CFA with SEM revealed that multi-factor modelling produced first- and second-order models that could be used to define the EATMOT scale, the first presenting better fitting indices, with the goodness-of-fit and comparative-fit indices very close to 1, as well as root-mean-square-error-of-approximation, root-mean-square-residual and standardised-root-mean-square-residual at practically zero. CONCLUSION: The validated EATMOT scale guarantees confidence in the information obtained through this instrument, and can be used in future studies to better understand food choice determinants in different geographical areas and help plan strategies to improve healthy eating patterns and diminish the burden of non-communicable diseases.

Study about Food Choice Determinants According to Six Types of Conditioning Motivations in a Sample of 11,960 Participants.

Many aspects linked to personal characteristics, society and culture constitute some of the motivators that drive food choice. The aim of this work was to determine in what extent the eating behaviors of individuals are shaped by six different types of determinants, namely: health, emotions, price and availability, society and culture, environment and politics, and marketing and commercials. This is a descriptive cross-sectional study, involving a non-probabilistic sample of 11,960 participants from 16 countries. The objective of this work was to validate the questionnaire, so as to make it suitable for application in different contexts and different countries. For that, six scales were considered for validation by confirmatory factor analysis with structural equation modelling. The obtained results showed that the six individual scales evaluated presented good or very good fitting indices, with saturation in goodness-of-fit index in all cases. The values of chi-square ratio were 6.921 (for health), 0.987 (environment), 0.610 (emotions) and 0.000 in the remaining cases (convenience, society, marketing). Furthermore, the fit was perfect, with saturation for all indices, in three of the six models (convenience, society and marketing). The results of this wok allowed the validation of the six scales, and the assessing of different types of factors that can influence food choices and eating behaviors, namely in the categories: health, emotions, price and availability, society and culture, environment and politics, and marketing and commercials.

Knowledge about dietary fibre and its health benefits: A cross-sectional survey of 2536 residents from across Croatia.

This cross-sectional study is aimed at identifying the level of understanding of the health benefits of dietary fibre in the prevention of disease, as well as the association between that understanding and fibre consumption in the Croatian population. We believe that nutritional knowledge is important for the consumption of healthy food which includes also a positive reflection on food habits and health. Only well-informed consumers can shop effectively for food rich in dietary fibre and thereby derive the health benefits that fibre can offer. We suppose the association between that understanding and fibre consumption in the Croatian population. However, this knowledge is not the only important determinant; food purchases are influenced by socioeconomic and demographic factors. Our hypothesis is that the level of knowledge about fibre and fibre consumption varies with age, gender, education level and urban or rural environment. It is our assumption that life styles, environmental conditions and education can affect the level of knowledge and perception about healthy eating habits. If this assumption is accurate, targeted education campaigns to educate and sensitise the population about fibre-rich foods and the health benefits of fibre is a priority. Public health programmes are urgently needed, particularly in rural areas, to sensitise the population to fulfill the recommended fibre intake, high-fibre food sources and the mechanisms by which fibre can help prevent disease.

Consumer knowledge and attitudes toward healthy eating in Croatia: a cross-sectional study.

Unlike fast and restaurant food, diet rich in fibre is known to contribute significantly to health. The aim of our study was to assess eating habits such as consumption of fibre-rich, fast, and restaurant food of the general population in Croatia. For this purpose we used a validated survey designed by the Polytechnic Institute Viseu in Portugal, which includes questions about demographics, good eating habits related to the consumption of the main sources of dietary fibre (fruit, vegetables, and whole grains), and unhealthy eating habits related to the consumption of fast food and restaurant meals. Between October 2014 and March 2015 we received answers from 2,536 respondents aged between 18-70 years, of whom 67.4 % were women and 32.6 % were men. Most respondents reported consuming one serving of vegetables and one piece of fruit a day, and whole grains every other day. Women and urban residents reported consuming larger amounts of fruit, vegetables, and whole grains than men (p<0.001). Men, in turn, reported eating out and eating fast food more often than women (p<0.001). Eating out highly correlated with eating fast food, which translates to lower consumption of dietary fibre (p<0.001). Higher education correlated positively with the consumption of fibre-rich food, but it also correlated positively with the consumption of fast and restaurant food (p<0.001). While eating fast food is not the predominant dietary practice in Croatia, over 50 % of respondents have reported eating fast food at least once a week. Our data also indicate that consumption of fruit, vegetables, and whole grains falls below the national and international dietary recommendations.