A deductive thematic analysis of nurses with job-related problems who completed suicide during the early COVID-19 pandemic: A preliminary report.

BACKGROUND: Prior to the novel coronavirus (COVID-19) pandemic, nurses died by suicide more frequently than the general population. Antecedents prior to death include known job problems, such as disciplinary action; diversion of medications; inability to work due to chronic pain; and physical and mental illness. AIM: The aim of this study was to explore the suicide experience of nurses who died with known job-related problems during the early phase of the COVID-19 pandemic compared to what has been previously described. METHOD: Deductive reflexive thematic analysis was used to analyze narratives of nurses with known job problems who died by suicide from the Centers for Disease Control and Prevention's National Violent Death Reporting System. RESULTS: Forty-three nurses with known job-related problems completed suicide between March and December 2020. Factors associated with death were similar to previous findings with notable exceptions, increased prevalence of suicidal ideation and post-traumatic stress prior to the event. Pandemic-specific issues were noted including reduction in hours, fear of disease transmission, civil unrest, and grief-related trauma. LINKING EVIDENCE TO ACTION: Suicide prevention programs need to address both institutional and individual factors associated with nurse suicide. As previously recommended, transitions into retirement and job loss are vulnerable times warranting psychological support. Further, strategies to reduce the impact of stressors and increase support for nurses are needed at the organizational level. A systems level approach to hardwire coping strategies is indicated pre-licensure and throughout nurses' careers. A new focus on how to process personal and professional grief is warranted. Resources are needed for nurses traumatized by life (rape, childhood trauma) or work-related experiences.

Correction: Relative Importance and Additive Effects of Maternal and Infant Risk Factors on Childhood Asthma.

[This corrects the article DOI: 10.1371/journal.pone.0151705.].

Relative Importance and Additive Effects of Maternal and Infant Risk Factors on Childhood Asthma.

BACKGROUND: Environmental exposures that occur in utero and during early life may contribute to the development of childhood asthma through alteration of the human microbiome. The objectives of this study were to estimate the cumulative effect and relative importance of environmental exposures on the risk of childhood asthma. METHODS: We conducted a population-based birth cohort study of mother-child dyads who were born between 1995 and 2003 and were continuously enrolled in the PRIMA (Prevention of RSV: Impact on Morbidity and Asthma) cohort. The individual and cumulative impact of maternal urinary tract infections (UTI) during pregnancy, maternal colonization with group B streptococcus (GBS), mode of delivery, infant antibiotic use, and older siblings at home, on the risk of childhood asthma were estimated using logistic regression. Dose-response effect on childhood asthma risk was assessed for continuous risk factors: number of maternal UTIs during pregnancy, courses of infant antibiotics, and number of older siblings at home. We further assessed and compared the relative importance of these exposures on the asthma risk. In a subgroup of children for whom maternal antibiotic use during pregnancy information was available, the effect of maternal antibiotic use on the risk of childhood asthma was estimated. RESULTS: Among 136,098 singleton birth infants, 13.29% developed asthma. In both univariate and adjusted analyses, maternal UTI during pregnancy (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.18, 1.25; adjusted OR [AOR] 1.04, 95%CI 1.02, 1.07 for every additional UTI) and infant antibiotic use (OR 1.21, 95%CI 1.20, 1.22; AOR 1.16, 95%CI 1.15, 1.17 for every additional course) were associated with an increased risk of childhood asthma, while having older siblings at home (OR 0.92, 95%CI 0.91, 0.93; AOR 0.85, 95%CI 0.84, 0.87 for each additional sibling) was associated with a decreased risk of childhood asthma, in a dose-dependent manner. Compared with vaginal delivery, C-section delivery increased odds of childhood asthma by 34% (OR 1.34, 95%CI 1.29, 1.39) in the univariate analysis and 11% after adjusting for other environmental exposures and covariates (AOR 1.11, 95%CI 1.06, 1.15). Maternal GBS was associated with a significant increased risk of childhood asthma in the univariate analysis (OR 1.27, 95%CI 1.19, 1.35), but not in the adjusted analysis (AOR 1.03, 95%CI 0.96, 1.10). In the subgroup analysis of children whose maternal antibiotic use information was available, maternal antibiotic use was associated with an increased risk of childhood asthma in a similar dose-dependent manner in the univariate and adjusted analyses (OR 1.13, 95%CI 1.12, 1.15; AOR 1.06, 95%CI 1.05, 1.08 for every additional course). Compared with infants with the lowest number of exposures (no UTI during pregnancy, vaginal delivery, at least five older siblings at home, no antibiotics during infancy), infants with the highest number of exposures (at least three UTIs during pregnancy, C-section delivery, no older siblings, eight or more courses of antibiotics during infancy) had a 7.77 fold increased odds of developing asthma (AOR: 7.77, 95%CI: 6.25, 9.65). Lastly, infant antibiotic use had the greatest impact on asthma risk compared with maternal UTI during pregnancy, mode of delivery and having older siblings at home. CONCLUSION: Early-life exposures, maternal UTI during pregnancy (maternal antibiotic use), mode of delivery, infant antibiotic use, and having older siblings at home, are associated with an increased risk of childhood asthma in a cumulative manner, and for those continuous variables, a dose-dependent relationship. Compared with in utero exposures, exposures occurring during infancy have a greater impact on the risk of developing childhood asthma.

Urine Club Cell 16-kDa Secretory Protein and Childhood Wheezing Illnesses After Lower Respiratory Tract Infections in Infancy.

Background: Infants with lower respiratory tract infections (LRTIs) are at an increased risk of developing childhood wheezing illnesses (including asthma), but it is not currently possible to predict those at risk for these long-term outcomes. The current objective was to examine whether urine levels of club cell 16-kDa secretory protein (CC16) at the time of an infant LRTI are associated with the development of childhood wheezing illnesses. Methods: Prospective study of 133 previously healthy infants enrolled during a healthcare visit for a LRTI and followed longitudinally for childhood wheezing illnesses. Urine levels of CC16 at the time of enrollment were measured after validating a commercially available enzyme-linked immunosorbent assay kit for serum. The outcome of interest was parental report of subsequent childhood wheeze (defined as ≥1 episode of wheezing following the initial LRTI) at the 1-year follow-up visit. Logistic regression was used for the main analysis. Results: The median (interquartile range) urine levels of CC16 (ng/mg of creatinine) at the time of an infant LRTI were 11.1 (7.7-20.1) for infants with subsequent childhood wheeze and 13.4 (8.3-61.1) for those without (p = 0.11). In the main multivariate analysis using a logarithmic transformation of the urine levels of CC16, a twofold increase in urine levels of CC16 was associated with ∼30% decreased odds (OR = 0.74 [95% confidence interval (CI) 0.56-0.98], p = 0.04) of subsequent childhood wheeze after adjustment for potential confounders. Conclusions: An inverse association was found between urine levels of CC16 at the time of an infant LRTI and the odds of subsequent childhood wheeze. Urine CC16 may be a useful biomarker of the development of childhood wheezing illnesses after LRTIs in infancy.

Response to infections in patients with asthma and atopic disease: an epiphenomenon or reflection of host susceptibility?

Associations between respiratory tract infections and asthma inception and exacerbations are well established. Infant respiratory syncytial virus and rhinovirus infections are known to be associated with an increased risk of asthma development, and among children with prevalent asthma, 85% of asthma exacerbations are associated with viral infections. However, the exact nature of this relationship remains unclear. Is the increase in severity of infections an epiphenomenon, meaning respiratory tract infections just appear to be more severe in patients with underlying respiratory disease, or instead a reflection of altered host susceptibility among persons with asthma and atopic disease? The main focus of this review is to summarize the available levels of evidence supporting or refuting the notion that patients with asthma or atopic disease have an altered susceptibility to selected pathogens, as well as discussing the biological mechanism or mechanisms that might explain such associations. Finally, we will outline areas in need of further research because understanding the relationships between infections and asthma has important implications for asthma prevention and treatment, including potential new pathways that might target the host immune response to select pathogens.

The effects of a social media policy on pharmacy students' facebook security settings.

OBJECTIVE: To examine how students entering a doctor of pharmacy (PharmD) program used Facebook privacy settings before and after the college's social media policy was presented to them. METHODS: The Facebook profiles of all entering first-year pharmacy students across 4 campuses of a college of pharmacy were evaluated. Ten dichotomous variables of interest were viewed and recorded for each student's Facebook account at 3 time points: before the start of the semester, after presentation of the college's social media policy, and at the end of the semester. Data on whether a profile could be found and what portions of the profile were viewable also were collected. RESULTS: After introduction of the policy, a significant number of students increased their security settings (made information not visible to the public) related to Facebook walls, information pages, and links. CONCLUSIONS: Making pharmacy students aware of a college's social media policy had a positive impact on their behaviors regarding online security and privacy.