Stressful Experiences Research Articles

Teaching Adolescents about Stress Using a Universal School-Based Psychoeducation Program: A Cluster Randomised Controlled Trial

Psychoeducation programs may increase knowledge about stress and help adolescents cope with stress. However, research about the effectiveness of psychoeducation programs about stress for adolescents is limited. The present study aimed to fill this gap by evaluating the effect of a brief school-based universal psychoeducation program about stress, the Stress Lessons, in terms of knowledge and experienced stress. A total of 1613 adolescents (M = 13.41 years) from Dutch secondary schools participated. A cluster randomised controlled design was employed: classes were randomly assigned to an experimental or control condition. The experimental condition received three Stress Lessons between pre- and post-test. The Stress Lessons provided information about stress, how to recognize stress, and how to cope with and prevent stress. Questionnaires were used to assess knowledge about stress as well as experienced stress. Multilevel analyses were conducted to examine the effectiveness of the Stress Lessons and the moderating effect of gender, educational track, and ethnic background. Results showed that knowledge gain was significantly greater in the experimental than in the control condition. Experienced stress did not change due to the Stress Lessons. Moderator analyses revealed a larger effect of the Stress lessons in terms of knowledge about stress for girls compared to boys and for adolescents who followed academic compared to vocational education. Overall, the findings show that a brief psychoeducation program leads to a better understanding of stress. Therefore, it may be useful for schools to implement such programs to enhance adolescents’ awareness.

Unmet Needs, Minority Stress and Mental Health Outcomes Among Transgender Individuals: The Mediating Role of Schema Domains.

Exposure to gender-related minority stressors, the negative experiences and beliefs that stem from anti-trans stigma increases transgender and gender diverse (TGD) people's vulnerability to experiencing poor mental health outcomes. This study examined if the relationships between experiences of minority stress and mental health outcomes were mediated by early maladaptive schemas: mental representations shaping the way people view themselves, others and the world. Drawing from a schema therapy perspective, the study additionally examined if caregivers' failure to meet TGD people's core emotional needs was associated with mental health outcomes and if schemas similarly mediated these relationships. A total of 619 TGD adults completed an online survey about early maladaptive schemas, core emotional needs, gender-related minority stress and psychological distress and wellbeing. Causal mediation analyses indicated that caregivers who did not meet TGD people's core emotional needs and greater experiences of minority stress were associated with increased distress and lower wellbeing. These relationships were mediated by schema severity, particularly the disconnection and rejection and impaired autonomy domains. These findings provide empirical support for the schema therapy model's assumption that unmet core emotional needs are associated with schema formation. For TGD people, maladaptive beliefs about the self, others and world can form in response to manifestations of anti-trans stigma within the individual, their interpersonal relationships, community and broader society. Caregivers' failure to meet needs, plus experiences of minority stress throughout the individual's system, leads to greater distress and lower wellbeing; however, clinical interventions targeting schemas may improve outcomes for this at-risk group.

Prepandemic Factors Associated With Pandemic Impact and Psychosocial Distress Among Mothers of Young Children

ObjectiveTo describe the Coronovirus 19 (COVID-19) pandemic impact among mothers of young children (0–8 years) and assess prepandemic factors associated with greater pandemic impact and psychosocial distress. MethodsMothers from 3 US birth cohorts (n = 301, mean child age 2.4 years) reported on demographics and psychosocial distress (anxiety, perceived stress, financial stress) before the pandemic (February 2015–February 2020). During the pandemic (July 2020–June 2021), they completed a supplemental survey about the impact of the pandemic on their families (Coronavirus Impact Scale) and psychosocial distress. Multivariable linear and ordinal logistic regression were used to evaluate prepandemic factors associated with pandemic impact overall and by domain. ResultsCompared to prepandemic reports, maternal anxiety symptoms increased by 9.4%, perceived stress increased by 13.3%, and financial stress increased by 41.7%, of which all were statistically significant changes. Participants reported the most severe pandemic impact in family routines (72.4%), experiences of stress (40.2%), and social support (38.6%). Mothers with some college or a 4-year degree experienced higher overall pandemic impact compared to mothers with the least and highest education. Prepandemic distress was not associated with pandemic impact; however, midpandemic, all 3 distress measures were significantly positively associated with overall Coronavirus Impact Scale, with the largest effect size noted for perceived stress (B = 1.36, 95% CI: 0.90,1.82). ConclusionsWhile, on average, mothers of young children experienced worsening psychosocial stress during the COVID-19 pandemic, prepandemic psychosocial stress alone was not prospectively associated with greater pandemic impact, suggesting that the COVID-19 pandemic may have both elaborated existing systemic social inequalities and created new burdens.

Post-Traumatic Stress in the Pregnancy-to-Postpartum Transition Among Birthing People With Opioid Use Disorder [ID 2683444

INTRODUCTION: Postpartum people with opioid use disorder (OUD) face unique challenges; post-traumatic stress may trigger substance use recurrence and disrupt the parent–infant dyad. However, the effects of traumatic stress in the pregnancy-to-postpartum transition for birthing people with OUD are not well investigated. Our study characterizes post-traumatic stress after birth among people in OUD treatment during the fourth trimester. METHODS: This a priori secondary study uses longitudinal data investigating recovery among postpartum people with OUD receiving buprenorphine. Participants were enrolled during the third trimester and assessed within 2 weeks postpartum. Scores greater than 29 on the PTSD Checklist-Civilian at 2 weeks postpartum identified post-traumatic stress. Other measures included the following: maternal attachment, perceived control in childbirth, trauma history questionnaire, and child welfare involvement. VCU IRB #HM20017030 approved this study. RESULTS: Participants (N=19) were predominantly White (74%). Most (94.7%) endorsed a traumatic event history before delivery of this infant. Eight (42%) met criteria for post-traumatic stress postpartum and identified birth (n=2), infant medical issue (n=3), or unrelated event (n=3) elicited the post-traumatic stress response. Of these, approximately 25% experienced food insecurity and limited health care transportation. These participants reported high levels of maternal attachment (28.1 [SD=4.8]) and perceived control in childbirth (44.3 [SD=6.3]). Most participants reported postpartum child welfare involvement. CONCLUSION: Nearly half of our sample experienced post-traumatic stress symptoms after birth, and two-thirds attributed symptoms to a traumatic birth or infant medical issue. Qualitative investigations are warranted to better understand the patient perspective of these experiences and their unique intersections with OUD treatment and recovery to ultimately improve trauma-informed care strategies.

“Parents are our greatest asset but also our greatest challenge”: A Qualitative Study of Anesthesia Staff’s Experiences of Parental Presence During Anesthesia Induction

PurposeThe perioperative period is a stressful experience for both the child and their parents. Anesthesia staff generally have a positive attitude to the parental presence in the operating room. They can be a powerful resource in creating a caring environment, but they are challenged by limited time to establish a relationship. The present study describes the anesthesia staff’s experience of parental presence during their child’s anesthesia induction. DesignA descriptive design with a phenomenological approach. MethodsA total of 22 anesthesia staff from four Swedish hospitals were interviewed. The study has been carried out using a reflective lifeworld research (RLR) approach. FindingsThe following four constituents describe anesthesia staff’s experiences of parental presence: a conditional presence; a relationship that is secondary; a shared but two-part responsibility; and a need to demonstrate professionalism. ConclusionsParental presence is natural and essentially irreplaceable, as it creates security for the child. However, the results show that parental presence is not free of obligations and expectations. Designing for good perioperative care is important, and the staff plays a key role in cooperating with the parents to improve the quality of care.

Teacher stress and ideal solutions: A qualitative comparison across elementary and middle school teachers.

Educators' high levels of stress have been well documented in existing literature, though little research has directly looked at comparisons of stress experiences and needs for support based on school level. The present study included 33 teachers (19 elementary and 14 middle school) from one school district who participated in semistructured interviews. Responses to questions regarding their primary source(s) of stress and their ideal solution(s) to relieve that stress revealed distinctions between elementary and middle school teachers. Elementary teachers described stress related to a sense of responsibility or need to care for students and meet their social, emotional, behavioral, and academic needs. Their ideal solution primarily involved receiving more emotional support and more support staff in the classroom to help meet all students' needs. In contrast, middle school teachers reported the majority of their stress as stemming from external demands or pressures such as test scores, high or unattainable expectations from administrators or parents, and not having enough time. Middle school teachers' ideal solutions largely entailed a shift in the use of their time, specifically to remove tasks (e.g., unnecessary staff meetings) and be able to focus their time on what matters the most (e.g., teaching students). These findings indicate that although almost all of these teachers reported being highly stressed, their sources of stress and perceived needs for support varied based on school level. Efforts to promote teacher well-being must consider school level and teachers' own perspectives on what they need in order to provide the most beneficial supports. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

(COVID)-19 Risk Perception, Stress-coping, and Life Satisfaction Differences in Leisure Involvement among Korean Immigrants in the United States

Objectives: COVID-19 has had an unprecedented impact on everyone's life, and Asian immigrants, including Korean immigrants, were one of the most vulnerable groups during this period. Prior studies have reported that leisure participation can be used as an effective strategy to cope with stressful and traumatic life experiences and promote improved health and well-being. Methods: In this study, 237 Korean immigrants living in the United States were asked to complete an online survey to explore the differences in COVID-19 risk perception, stress-coping, and health due to leisure involvement levels. Results: The results showed that the Highly Active Leisure Group (HALG) demonstrated significantly lower stress perception and higher levels of life satisfaction compared to the Moderately Active Leisure Group (MALG) and the Less Active Leisure Group (LALG). However, we found no statistically significant differences in COVID-19 risk perception and resiliency between the groups. Conclusions: This research highlights the importance of active leisure participation in coping with stressors related to traumatic life events such as pandemics. To encourage active leisure involvement among ethnic minorities, such as Korean immigrants, recreation and sports professionals and local community leaders should strive to design and develop more culturally appropriate programs that incorporate activities associated with Asian cultures.

Evaluation of Anxiety Levels and Related Factors in Parents of Preterm Infants Hospitalized in NICU

Background: The hospitalization of preterm infants in Neonatal Intensive Care Unit (NICU) is generally an unexpected event that can be stressful experience for families and especially for parents. Objective: To assess the anxiety levels in parents with preterm infants hospitalized in NICU and determine its association with clinical and sociodemographic variables. Method: This prospective, follow up–cohort study was conducted at the NICU of a tertiary maternity hospital in Athens, Greece during 18/12/2019 to 31/12/2022. A total of 120 parents, whose infants had birth weight (BW)<1750 grams (g) and gestational age (GA)<34 weeks (w) were involved. The data collected by a demographic form and the State-Trait Anxiety Inventory Scale (STAI). Results: Our data showed that the STAI score for state anxiety to mothers was significantly higher in the 1st assessment (Mean±SD:52.2±11.9) than 2nd (Mean±SD:47.8±12) and 3rd (Mean±SD:49±10.3). The STAI score for trait anxiety was similar, in particular it was significantly higher in the 1st assessment (Mean±SD:46.6±14.6) compared to 2nd (Mean±SD:41.9±14) and 3rd (Mean±SD:42.8±13). Also, the STAI score for state anxiety to fathers was significantly higher during the 1st assessment (Mean±SD:47.1±12.2) compared to the other two assessments (Mean±SD:42.8±9.8 & Mean±SD:41.7±9.1 respectively), while trait anxiety didn’t show significant variability. Conclusion: Our findings suggested that the premature birth and infant’s hospitalization might have a negative effect on parents’ emotional state. Identifying which mothers and fathers are at risk immediately after birth and during NICU stay could help to direct specific interventions that can prevent them of stressful feelings.

A qualitative study exploring experiences of racial minority stressors in pharmacy education and practice

Abstract Introduction Despite 49.1% of registered pharmacists in the UK identifying Black, Asian, or from a Minority Ethnic (BAME) background, senior management roles within pharmacy are dominated by white males.[1] People from BAME communities may experience racial minority stressors. Racial minority stressors are behaviours which range from unconscious bias, micro-aggression, and overt racism (macro-aggression). However, there is little evidence describing experiences of racial minority stressors in pharmacy practice and education. Aim To explore experiences of racial minority stressors in pharmacy education and practice. Methods A convenience sample of pharmacy students, trainees and pharmacists were recruited via email and social media posts to voluntarily take part in interviews and focus groups. Inclusion criteria were: be over 18 years old, conversant in English, capacity to give consent to take part in research and be either a pharmacy student, trainee or registered pharmacist. The only exclusion criterion was where the inclusion criteria were not met. Interviews and focus groups were held online using Microsoft Teams. A topic guide was generated from key themes in the literature and used during data collection to explore experiences of racial minority stressors in education and practice. Interviews and focus groups were transcribed verbatim and inductively analysed using thematic analysis underpinned by a phenomenological approach. Ethical approval was obtained from Newcastle University Ethics Committee. Results Forty-five participants were recruited. Six focus groups and sixteen one-to-one semi-structured interviews were conducted. The sample was varied, with 56% (n=25) students and 33% (n=15) registered pharmacists from community, hospital, primary care, academia and an additional 11% (n=5) still in foundation training in these sectors. The sample included a diversity of racial identities, including 40% (n=18) South Asian, 27% (n=12) White, 15% (n=7) Black, 7% (n=3) Chinese 7% (n=3) Arab, 2% (n=1) mixed, and 2% (n=1) not disclosed. Three themes were identified – Theme 1) Experiences of racial minority stress, Theme 2) Making sense of racial minority stress, and Theme 3) Responding to racial minority stress. Participants experiences of stressors were based on personal characteristics (for example skin colour, dialect, religious dress) which made them feel susceptible to judgement, racist comments and microaggressions in education and practice. Participants required time to make sense of, interpret, and understand experiences of racial minority stress. This was influenced by the sources of stressors, which included patients, the public, and colleagues as well as institutions and policies. Participants responded by ‘ignoring’ stressors from patients and the public which were thought to be due to ignorance or ill-health and ‘masking’ negative feelings if sources of stress were colleagues or institutions due to fear of negative impacts on training and career progression. Conclusion This study shows dealing with microaggressions, racial minority stress and judgement in pharmacy education and practice is a burden experienced by people from BAME backgrounds. This may contribute to the professional attainment gap in pharmacy, as these experiences are an additional burden that pharmacists, trainees, and students must bear compared to their non-BAME counterparts. Further research is needed to explore interventions to reduce minority stress.

The moderating role of conscientiousness in the temporal association of stress on sleep.

Personality traits have been associated with sleep problems and stress experience. However, their impact on objective sleep and the temporal relationship of stress on sleep has remained elusive. This study examined whether daytime stress predicts sleep the following night, and the moderating role of neuroticism and conscientiousness in this relationship. To introduce stress variability in natural daily stressors, we measured college students (N = 92) during exams (e.g. high academic stress) and at the start of new course period (e.g. low academic stress). Both objective (actigraphy) and subjective sleep, and daily self-reported stress, were measured for 14 days and personality traits once. Reported daily stress was significantly higher in the exam period compared with baseline, suggesting that our natural manipulation did indeed result in variation in stress levels. Intra-individual daily variations in stress were not associated with the following night's sleep timing, duration or fragmentation, implying that more stress during the day did not affect sleep the following night. Higher levels of neuroticism were associated with poorer daily subjective sleep quality and higher stress levels over the complete period. Neuroticism did not moderate the temporal association of stress on sleep. Conscientiousness moderated the association between intra-individual stress and sleep fragmentation, and intra-individual stress and wake-up time. This implied that highly conscientious participants experienced less sleep fragmentation and woke-up earlier after more stressful days. These results suggest an interconnected relationship among stress, sleep and personality. Focusing on one aspect, like handling stress or enhancing sleep quality, might yield positive effects on the rest.

Social Support Postpartum: Bengali Women from India on Their Coping Experiences following Childbirth.

Undertaken in Kolkata, India, our study aimed to explore the experiences of Bengali middle-class women on perceived stressful events, social support, and coping experiences following childbirth. Becoming a mother following childbirth is a shared phenomenon irrespective of culture, social strata, or country, while stress during the postpartum period or depression is not. Discrete medical intervention does not sufficiently address the complexities of postpartum experiences since influencing factors also include economic, political, cultural, and social backgrounds. Adopting a feminist and phenomenological approach, individual in-person interviews were conducted with twenty women recruited via snowball sampling. Our findings revealed that events experienced as stressful may lead to poor postpartum well-being. Underpinned by gendered discourse and biases, stressful events included familial imperatives for a male child, poor social and emotional support from the family, mostly partners and fathers, and systemic workplace barriers. The women in our study commonly resided with their mothers postpartum. They expressed feeling sheltered from these experiences, cared for, and supported. We discuss the women's experiences from a feminist pragmatic worldview, which advocates for a flexible feminism recognizant of the unique and nurturing relationship experiences between Bengali middle-class women and their mothers. In conclusion, we advocate for culturally sensitive, women-centered postpartum care practices that may entail the inclusion of intergenerational care during this critical phase of maternal well-being. These insights underscore the necessity of tailoring postpartum support systems to align with the cultural and familial contexts of the individuals they serve.

How to Create Healthy, Stress-Resilient Post-Pandemic Cities

This article analyzes the correlation between the city size, population density and character of three Polish cities and the following aspects: (1) inhabitants’ subjective stress level and its change during the COVID-19 pandemic, (2) sources and effects of their stress during the pandemic, (3) ways of reducing stress by residents and the role of greenery in this respect and (4) directions of changes in the structure of post-pandemic cities desired by their residents. The main research method was geo-surveys, the results of which were developed using statistical analysis and GIS methods. On the basis of the constructed scale, respondents subjectively assessed the level of experienced stress and its change during the COVID-19 pandemic. The research shows that none of the considered features of cities (including size measured by the number of inhabitants) are related to the level of pandemic stress of their inhabitants. All of them, on the other hand, are correlated with the directions of urban spatial development desired by the residents, conducive to stress reduction. Furthermore, the size of the city and its character affect the subjectively perceived change in stress levels during the pandemic (compared to the stress level before pandemic). Some of the effects of pandemic stress and ways of reducing it depend on the character of the city. The stress experienced by the inhabitants is the lowest in cities with the largest share of green areas in the spatial structure (especially with forest complexes and naturally shaped areas of river valleys), where an effective system of greenery has been adopted (the Howard’s garden city model), and at the same time with dominant single-family housing. The research results were used to indicate new directions for shaping post-pandemic cities that are more resistant to stress and thus healthier for their residents.

Technique description: Extraction of engulfed ear-piercing backing – The fast and atraumatic technique

BackgroundEar piercings are a common practice for body modification and self-expression, but they can lead to various complications, including embedded jewelry, infections, and difficulty removing earring backings. Traditional techniques for removing stuck backings involve forceful manipulation, resulting in pain, scarring, and suboptimal cosmetic outcomes. DiscussionIn this technique description, we present an alternative atraumatic technique for the removal of stuck ear-piercing backings. The technique involves injecting a mixture of local anesthetic and a vasoconstrictor, around the backing to create a fluid pocket that loosens the earring post. A special maneuver is then applied using a needle driver allowing for easy gentle removal. If the backing remains embedded, gentle pressure on the earlobe reveals a loop that can be threaded with a syringe needle to propel the backing out. ConclusionsThe proposed atraumatic technique for removing stuck ear-piercing backings offers a satisfactory and less stressful experience for pediatric patients while reducing the need for emergency department referrals. Given the lack of consensus on extraction methods, this technique provides a valuable alternative in the absence of a widely agreed-upon approach. Further research is needed to establish standardized protocols. Nevertheless, adopting this technique has the potential to enhance patient satisfaction and improve outcomes.

The multifaceted role of RNA-based regulation in plant stress memory.

Plants have evolved interconnected regulatory pathways which enable them to respond and adapt to their environments. In plants, stress memory enhances stress tolerance through the molecular retention of prior stressful experiences, fostering rapid and robust responses to subsequent challenges. Mounting evidence suggests a close link between the formation of stress memories and effective future stress responses. However, the mechanism by which environmental stressors trigger stress memory formation is poorly understood. Here, we review the current state of knowledge regarding the RNA-based regulation on stress memory formation in plants and discuss research challenges and future directions. Specifically, we focus on the involvement of microRNAs (miRNAs), small interfering RNAs (siRNAs), long non-coding RNAs (lncRNAs), and alternative splicing (AS) in stress memory formation. miRNAs regulate target genes via post-transcriptional silencing, while siRNAs trigger stress memory formation through RNA-directed DNA methylation (RdDM). lncRNAs guide protein complexes for epigenetic regulation, and AS of pre-mRNAs is crucial to plant stress memory. Unraveling the mechanisms underpinning RNA-mediated stress memory formation not only advances our knowledge of plant biology but also aids in the development of improved stress tolerance in crops, enhancing crop performance and global food security.

Posttraumatic growth and related factors among relatives, caring for cancer patients. Systematic review (Part 2)

Caring for cancer patients can have not only negative impact on the informal caregivers, but can also be a source of positive personality transformations in the challenging situation associated with cancer.Aim: identification and synthesis of data on posttraumatic growth (PTG) and socio-demographic, clinical and psychological factors associated with PTG in relatives, caring for patients with cancer.Methods: The review was conducted according to the statement of the PRISMA guidelines. The review used 2 search strategies: systematic electronic search in databases (Pubmed, Google Scholar, Cochrane, EBSCO, SAGE journals и eLIBRARY), manual search of articles in references lists of eligible articles.Results: Psychological factors are crucial in development of PTG. Perceived social support (especially within the family) and constructive emotion- and problem-focused coping (such as positive reframing coping) are among the factors contributing to the PTG. The data on the positive relationship of with the severity of stressful experiences and emotional distress among caregivers predominate in the analyzed studies. At the same time, there is a lack of agreement on the contribution of psychological distress to the development of PTG.Conclusion: Development of supportive social environment, constructive coping strategies training, increase of family satisfaction, work with existential and spiritual values, and creation of psychological readiness of caring relatives for loss in case of negative prognosis for patients’ survival should be considered as the main directions of psychological interventions aimed at facilitating PTG in relatives caring for cancer patients.

Relationships among Cortisol, Perceived Stress, and Dental Caries Experience in Adolescents and Young Adults

Introduction: Stress can impact mental and physical health, especially during adolescence and young adulthood, but the extent of its contribution to dental caries is poorly understood. The present study assessed the association between perceived stress, cortisol levels (in hair and saliva), and overall caries experience of adolescents and young adults aged 15–25 years. Methods: Hair and saliva samples were obtained from 93 participants free of periodontal disease. Cortisol in hair and saliva was determined using a competitive enzyme-linked immunosorbent assay. Participants completed a perceived stress questionnaire and underwent full-mouth oral examination by a calibrated examiner. Dental caries experience was based on the decayed, missing, and filled teeth (DMFT) index. Sociodemographic variables were also recorded. Results: There were significantly higher hair cortisol levels and perceived stress scale (PSS) scores in individuals with dental caries experience (DMFT≥1) than in those without (DMFT = 0). However, there was no significant difference in salivary cortisol concentration. A binary logistic regression revealed that higher hair cortisol levels and greater scores on the perceived stress scale were associated with increased odds of having experienced dental caries. In contrast, no significant association was found between salivary cortisol concentration and dental caries. Using multivariable regression models, caries experience was found to be significantly associated with both hair cortisol levels and PSS scores. These associations remained statistically significant even after adjusting for sociodemographic variables. Conclusion: Hair cortisol levels and perceived stress have a significant association with dental caries experience, whereas salivary cortisol concentrations do not.

The Effects of the COVID-19 Pandemic on Healthcare Providers' Mental Health: Experiences at Kenyatta National Hospital, Kenya.

In 2020, healthcare providers were expected to provide care to individuals with coronavirus disease 2019 (COVID-19), putting them at risk of acquiring COVID-19. The possibility of acquiring poorly understood infectious diseases while providing care may have an impact on the mental health of providers. We conducted a study to explore the effects of COVID-19 on the mental health of healthcare providers. Between April and August 2021, we conducted in-depth interviews with 60 healthcare providers in the infectious disease unit (IDU) and other units of the hospital (non-IDU). The healthcare providers completed an online self-administered survey form with demographic data (age, sex, average income, and known contact with a COVID-19 patient). We used semi-structured interview guides to understand the healthcare providers' lived experiences of stress, anxiety, depression, and their associated factors. We transcribed the interviews verbatim and coded and analyzed the transcripts to derive thematic concepts related to mental health experiences. The healthcare providers had a median age of 37 years [IQR 20.0-58.0], and 56.7% were female, 30.0% nurses, 18.3% medical doctors, and 11.7% laboratory technologists. The healthcare providers reported increased stress during the pandemic, attributed to the high demand for patient care, changes in social life, and fear of COVID-19 infection. They also reported experiences of anxiety and depression as a result of limited knowledge at the beginning of the pandemic and the perception that "COVID-19 resulted in death". Testing positive for COVID-19, high exposure to COVID-19 risks, and the death of patients and colleagues reportedly affected the healthcare providers' mental health. Additionally, the healthcare providers reported mental health support through debriefing meetings, peer-to-peer support, and psychological counseling, with privacy and confidentiality concerns. Healthcare providers faced mental health issues such as stress and anxiety while taking care of COVID-19 patients. An effective mental health response requires institutional practices that address context-specific challenges such as privacy and confidentiality.

Appropriate Nitrogen Application for Alleviation of Soil Moisture-Driven Growth Inhibition of Okra (Abelmoschus esculentus L. (Moench))

Uneven rainfall, in the context of global warming, can cause soil moisture fluctuations (SMFs) that harm crop growth, and it is not yet known whether nitrogen (N) can mitigate the harm caused by a strong SMF. This paper uses okra as a test subject and sets three SMFs of 45–55% FC (W1), 35–65% FC (W2), and 25–75% FC (W3) and three N applications of 0 kg hm−2 (N0), 110 kg hm−2 (N1), and 330 kg hm−2 (N2) to investigate the effects of SMF and N application on the physiological and biochemical aspects of okra. The results demonstrated that okra exhibited the highest values in stem diameter, number of leaves, photosynthesis characteristics, antioxidant enzyme activity, and yield under the N1 treatment. The average yield in the N1 treatment was 149.8 g, significantly surpassing the average yields of the N0 (129.8 g) and N3 (84.0 g) treatments. Stomatal density, antioxidant enzyme activity, malondialdehyde content, and proline content in okra leaves were highest in the W3 treatment, indicating that plants experienced stress in the W3 treatment. However, the agronomic traits and yields of okra in the N1 treatment were higher than those in the N0 and N1 treatments, indicating that the crop damage caused by W3 could be mitigated by an appropriate amount of N application. The N1W1 treatment emerged as the most suitable combination for okra growth in this study, exhibiting the highest stem diameter, leaf count, photosynthetic characteristics, and yield (201.3 g). Notably, this yield was 67.8% higher than the lowest treatment (N2W3), signifying a significant improvement.

Leadership empowerment behavior and employee referrals: chain mediation of perceived challenge stress and employee experience

Purpose Internal employees of firms are a reliable source of information for potential job seekers. However, few studies have focused on why internal employees actively recommend their firms. Based on the social exchange theory, this study aims to construct a chain mediation model using perceived challenge stress and employee experience as mediators to explore how leadership empowerment behavior affects employee referrals. Design/methodology/approach Bootstrap repeated sampling analysis was conducted on a sample of 307 employees collected through two-time points. Findings Leadership empowerment behavior is positively related to employee referrals; perceived challenge stress and employee experience mediate the effect of leadership empowerment behavior on employee referrals, respectively; in addition, perceived challenge stress and employee experience play a chain mediating role between leadership empowerment behavior and employee referrals. Originality/value The findings can help provide insight into the drivers of employee referrals and can effectively guide organization reputation management.

The Maternal and Infant Environmental Health Riskscape study of perinatal disparities in greater Houston: rationale, study design and participant profiles.

The Maternal and Infant Environmental Health Riskscape (MIEHR) Center was established to address the interplay among chemical and non-chemical stressors in the biological, physical, social, and built environments that disproportionately impact perinatal health among Black pregnant people in a large and diverse urban area with documented disparities in the U.S. The MIEHR cohort is recruiting non-Hispanic Black and non-Hispanic white pregnant people who deliver their infants at major obstetric hospitals in Houston, Texas. At enrollment, all participants are asked to provide urine samples for chemical [metals, cotinine, and polycyclic aromatic hydrocarbons (PAHs)] analyses and blood samples. A subset of the cohort is asked to provide oral and vaginal swabs, and fecal samples. Questionnaire and electronic health record data gather information about residential address history during pregnancy, pregnancy history and prenatal care, sociodemographic and lifestyle factors, experiences of discrimination and stress, and sources of social support. Using information on where a participant lived during their pregnancy, features of their neighborhood environment are characterized. We provide summaries of key individual- and neighborhood-level features of the entire cohort, as well as for Black and white participants separately. Between April 2021 and February 2023, 1,244 pregnant people were recruited. Nearly all participants provided urine samples and slightly less than half provided blood samples. PAH exposure patterns as assessed on 47% of participants thus far showed varying levels depending on metabolite as compared to previous studies. Additionally, analyses suggest differences between Black and white pregnant people in experiences of discrimination, stress, and levels of social support, as well as in neighborhood characteristics. Our findings to date highlight racial differences in experiences of discrimination, stress, and levels of support, as well as neighborhood characteristics. Recruitment of the cohort is ongoing and additional neighborhood metrics are being constructed. Biospecimens will be analyzed for metals and PAH metabolites (urine samples), miRNAs (plasma samples) and the microbiome (oral swabs). Once enrollment ends, formal assessments are planned to elucidate individual- and neighborhood-level features in the environmental riskscape that contribute to Black-White disparities in perinatal health.