Challenges and strategies of early career nurse scientists when the traditional postdoctoral fellowship is not an option.

PURPOSE: The purpose of this article is to discuss challenges and strategies related to maintaining a program of research for early career nurse scientists. Nurse scientists who do not complete a traditional postdoctoral fellowship or who work in low research-resourced institutions may struggle with research collaboration and development. PRINCIPAL RESULTS: Specific challenges experienced by nurse scientists in early career development included: advanced age at the completion of the research doctorate, gender roles and research careers, sustainable work-life balance, employment in low research-resourced institutions, and time. Strategies to assist nurse scientists in finding support and opportunities for research and career development included: professional networking, institutional collaboration, non-traditional training experiences for new nurse scientists, sustainable work-life balance, professional development and service, and competing needs of teaching mission and research. One group's experience with fostering support and collaboration is presented as an example. MAJOR CONCLUSIONS: It is possible for nurse scientists in low research-resourced institutions to find opportunities to develop their program of research and foster their professional growth. Implementing the identified strategies helps to provide sustainability of new nurse scientists' research efforts. Engaging nurse scientists in supportive and collaborative opportunities paves the way for early career nurse scientists to become experts in their field.

Bio-behavioural research in a rare disease population: a doctoral student's experience.

BACKGROUND: Novice researchers who aspire to contribute to the body of knowledge concerning rare diseases face unique challenges in developing and conducting studies. These include unknown effect sizes in previous research, limitations in recruitment and enrolment, and managing data from a multi-site sample. AIM: To describe the challenges in researching rare diseases and possible solutions using a doctoral student exemplar from a cross-sectional correlational study of fatigue. DISCUSSION: The authors discuss the lessons learned from the study, including the challenges in recruitment, communication, collecting biological data and managing data in general. They posit possible solutions, including improving multi-site coordination, feasible methods for exploring sleep and stress, and measures to prevent equipment and data loss. CONCLUSION: Rare populations, such as young survivors of childhood brain tumours, deserve a voice in building the body of knowledge needed for more precise, personalised healthcare. It is possible with foresight for the novice researcher to make such a contribution. IMPLICATIONS FOR PRACTICE: Improved knowledge and assessment of symptoms during childhood will improve the detection of health risk factors and enable earlier intervention.

Weight Gain and Blood Pressure in Toddlers Born Very Preterm.

BACKGROUND: Preterm birth is a risk factor for elevated blood pressure in childhood and the development of hypertension and cardiometabolic disease in adulthood; however, mechanisms for the development of both are poorly understood. Rapid weight gain early in childhood may serve as a driver directly and indirectly through cortisol levels found to be elevated in early childhood in individuals born preterm. OBJECTIVES: The objective of this pilot study was to examine the effect sizes of the relationships between weight gain and blood pressure in toddlers born very preterm. A secondary aim was to note any mediating effect of cortisol on the relationships between weight gain and blood pressure. METHODS: A cross-sectional design with a convenience sample of 36 toddlers who were born very preterm was used to examine the relationships between postnatal weight gain, cortisol, and blood pressure at follow-up. RESULTS: Many of the participants experienced rapid weight gain in the first 12 months of life. Mean systolic and diastolic readings were 94 and 56.6, respectively. Diastolic blood pressure readings were obtained from 23 participants, and the majority were elevated. Weight gain was associated with diastolic blood pressure with a medium effect size. A mediating role with cortisol was not supported. DISCUSSION: Although findings need to be validated in a larger sample, the blood pressure elevations in this sample were alarming. If readings continue to amplify as these children age, the fact that elevations are already present during the toddler period could indicate more significant cardiovascular disease in adulthood for this population. Rapid weight gain in early life may be a driver for elevated blood pressure even during early childhood in individuals born preterm.

Recruitment of hard to contact, hard to engage child populations in clinics and schools.

Recruiting children with chronic disease or subgroups of children (low income, obese, specific ages, types of cancer) from clinics and schools for research studies may be particularly difficult. While some have deemed such groups as hard to reach, these groups may be more accurately described as either hard to contact or hard to engage. This is not because children are unknown to the school or clinic but because the researcher's ability to communicate directly with targeted children prior to enrollment is limited. The purpose of this paper is to describe barriers and possible strategies for recruiting hard to contact or hard to engage subgroups of children. Barriers identified in recruiting these children were: naïve to research, communication style and technology, parent/guardian burden, parental conditions and concerns, child stressors and distractions, and research setting. Possible strategies include: pre-consent education, information sheets about study, identifying preferred method of communication, meaningful and appropriate incentives, coordinating recruitment visit with regularly scheduled clinic appointments or school schedule, demonstrating research equipment, informing staff about research study, negotiating creatively for space for research, and emphasizing confidentiality of data. Consideration of barriers to recruitment and utilization of strategies to counteract these barriers is critical to the success of a study involving subgroups of children.

The Influence of Psychological Stress, Depressive Symptoms, and Cortisol on Body Mass and Central Adiposity in 10- to-12-Year-Old Children.

PURPOSE: The purpose of this study was to examine the influence of psychological stress and depressive symptoms on body mass and central adiposity in 10-to-12-year-old children and to determine the mediating role of cortisol in the relationships among psychological stress, depressive symptoms, body mass, or central adiposity. DESIGN AND METHODS: The convenience sample included 147 children (84 females; 63 males) who were recruited from one middle school and three elementary schools in a rural area of a southeastern state. Height, weight, waist circumference (WC), and salivary cortisol were measured. Children completed the Rating Scale for Pubertal Development for screening, Children's Depression Inventory, and the Feel Bad Scale. Bivariate correlation, multiple regression analyses, and univariate regression techniques were used in data analyses. RESULTS: A positive relationship between psychological stress and depressive symptoms (r = 0.559, p < .001) was found. Depressive symptoms explained a significant amount of the variance in body mass index (BMI) (ß = 0.37, p ≤.001) and central adiposity (ß = 0.40, p ≤ .001) when sex, race/ethnicity, puberty, and socioeconomic status were controlled. No statistically significant relationships were found between psychological stress and cortisol or between depressive symptoms and cortisol. CONCLUSIONS: Depressive symptoms were reported by normoweight, overweight, and obese children. Depressive symptoms accounted for variance in body mass and central adiposity. Practice Implications In addition to regular screening of BMI and WC, nurses and other health care professionals need to consider psychological factors that contribute to childhood obesity.

Infant Feeding Practices and Weight Gain in Toddlers Born Very Preterm: A Pilot Study.

PURPOSE: Long-term consequences of prematurity are a public health concern. A pattern of slow initial weight gain followed by a period of rapid weight gain has been associated with poor cardiometabolic health outcomes. The purpose of this study was to examine the relationships between infant feeding practices and weight gain in a sample of 18-to-24-month olds corrected age born very preterm. DESIGN AND METHODS: A cross-sectional design was used to examine the relationships between infant feeding practices and weight gain. Estimates of effect sizes and model fit estimates were the primary parameters of interest. RESULTS: Most of the participants received human milk after birth, but most had transitioned to formula before three months. Slightly less than half received complementary foods prior to four months corrected age. Gains in weight and head circumference were rapid after discharge from the neonatal intensive care unit, while gains in length lagged behind. Infant feeding practices did not have a clinically meaningful effect on weight gain. CONCLUSIONS: While the initiation of human milk feedings was encouraging, the duration fell short of recommendations. Practices such as the early introduction of complementary feedings and the addition of rice cereal to the bottle are troubling. Additionally, the rapid increase in weight gain may have a negative impact on future cardiometabolic health. PRACTICE IMPLICATIONS: Clinical recommendations include ensuring support for the use of human milk before and after hospital discharge, close monitoring of physical growth, and ensuring adherence to the guidelines for the introduction of complementary foods.

Perceived Stress and the Fatigue Symptom Cluster in Childhood Brain Tumor Survivors.

OBJECTIVES: To explore and estimate relationships among the elements of the symptom cluster in survivors of brain tumors aged 8-12 years during early survivorship. SAMPLE & SETTING: Child participants completed treatment at least six months and less than six years prior to enrollment at Children's Hospital of Alabama in Birmingham or Cook Children's Medical Center in Fort Worth, Texas. METHODS & VARIABLES: With cross-sectional methods, the authors measured child-perceived stress, sleep-wake disturbance (SWD) (parent report), and fatigue. Children also provided saliva samples for cortisol measurement (stress response) and completed actigraphy sleep monitoring. RESULTS: Mild to moderate stress, SWD, and fatigue were reported, and a wide range of sleep times and cortisol levels were noted. Meaningful effect sizes in relationships between variables were found. IMPLICATIONS FOR NURSING: The stress, SWD, and fatigue symptom cluster in survivorship necessitates routine nursing assessment.

Factors That Influence Blood Pressure in 3- to 5-Year-Old Children: A Pilot Study.

While incident elevations in blood pressure (BP) are apparent in preschool years, factors influencing BP in this population have received little attention. The purposes of this pilot study were to determine the feasibility of collecting data from preschoolers and their mothers and to determine effect sizes of relationships between BP and sex, race, birth status, body mass index (BMI), waist circumference (WC), geographic location, serum C-reactive protein (CRP), and salivary cortisol (morning, afternoon). A hypothesis-generating correlational design was used; 56 children, aged 3-5 years, were enrolled from six rural and urban Head Start programs in a southeastern state. On Day 1 of data collection, mothers completed demographic questionnaires and children had blood drawn by finger stick. On Day 2, children gave saliva samples for cortisol, were measured for height by stadiometer, weight by digital scales, and WC by tape measure and had their BP measured by Dinamap. Incident elevations in BP were found in 30% of children (17/56), the majority of which were of systolic BP; 65% of those with elevations were of normal weight. Data collection was feasible with few problems. Small-to-medium effect sizes were noted for BP status (normal, prehypertensive, and hypertensive) and cortisol p.m. and birth status (parent-reported prematurity or term); small effect sizes were seen for BP status and BMI, race, sex, and geographic location. CRP and cortisol had medium- and small-to-medium effect sizes, respectively, with diastolic blood pressure. Studies with larger, more diverse samples need to be conducted to test hypotheses posited from these estimated effect sizes.

Post-Deepwater Horizon Oil Spill Exposure Patterns Among Children in Mobile County, Alabama.

OBJECTIVE: The aim of this study was to characterize environmental exposure from Deepwater Horizon oil spill among pre-K to fourth-grade children from six schools in Mobile County, Alabama. METHODS: A mail-in survey administered 11 months post-oil spill to children's parents/caregivers elicited information on exposure-related activities. Descriptive and multivariable analyses were performed. RESULTS: Overall, 180 children (coastal schools, 90; inland schools, 90) completed the survey. During the post-oil spill period, children in coastal schools were less likely to reduce their exposure-related activities, including fishing; eating and selling caught fish; visiting beaches; and parental participation in cleanup activities, than children in inland schools. Particularly, fishing and eating caught fish were significantly associated with the coastal group (odds ratio = 2.28; 95% confidence interval = 1.54 to 3.36). CONCLUSION: Proximity to the shoreline may serve as an indicator for potential exposure in oil spills among vulnerable populations including children.

Assessment of vascular function in low socioeconomic status preschool children: a pilot study.

Elevated brachial blood pressure (BP) in childhood tracks into adulthood. Central BP and measures of arterial stiffness, such as aortic augmentation index (AIx) and pulse wave velocity (PWV), have been associated with future cardiovascular disease. This pilot study assessed the feasibility of noninvasively measuring these parameters in preschool children and explored factors that may be associated with elevated BP in this age group. Brachial BP was measured using an electronic oscillometric unit (Dinamap PRO 100) and defined as elevated when systolic BP (SBP) and/or diastolic BP (DBP) was ≥ the 90th percentile for age, gender, and height. Central BP, AIx, and PWV were measured using applanation tonometry (SphygmoCor). C-reactive protein (CRP) was measured in serum samples. Sixteen African-American preschool children were recruited (4.4 ± 0.8 years, 69% males), 6 (38%) of whom had an elevated brachial BP (110 ± 10/69 ± 4 vs. 96 ± 8/55 ± 6 mm Hg, Cohen's d = 2.2). Children with elevated brachial BP had higher central SBP (d = 1.6) and DBP (d = 1.96) (97 ± 6/68 ± 4 vs. 85 ± 8/57 ± 6 mm Hg), AIx (d = 0.88) (31 ± 8 vs. 18 ± 16%, standardized to heart rate), and CRP (3.1 [2.3-6.3] vs. 0.1 [0.1-0.3] mg/dL, d = 2). There was no significant difference in PWV between groups (d = 0.26). CRP and SBP (Spearman r = 0.70), DBP (r = 0.68), central SBP (r = 0.58), and central DBP (r = 0.71) were positively correlated. Wide confidence intervals for the estimated effect sizes indicated a large degree of uncertainty about all estimates due to the small sample size. Noninvasive assessment of central BP and arterial stiffness is feasible in preschool children. Vascular inflammation may be an important factor that influences BP at an early age. Further studies in preschool children are needed to elucidate mechanisms of early onset hypertension.

Relationships Among Perceived Stress, Bullying, Cortisol, and Depressive Symptoms in Ninth-Grade Adolescents: A Pilot Study.

Adolescence is considered a critical period for risk of depressive symptoms, with prevalence ranging from 13% to 34%. Few studies have examined the relationships among perceived stress, bullying, and depressive symptoms accompanied by a biological marker of stress (cortisol). The purpose of this pilot study was to determine the feasibility of collecting biological specimens in a high school setting, including a morning and afternoon sample of salivary cortisol as well as computer-based survey data in order to examine the relationships among these variables in ninth-grade adolescents. A convenience sample of 31 ninth-grade students from a Southern suburban high school participated in this cross-sectional, correlational study. Perceived stress contributed the most toward the variance in depressive symptoms ( F = 29.379, df = 1, p < .001, partial eta square [[Formula: see text]] = 0.583). Females ( n = 15) had higher depressive symptoms scores than males, n = 16; t(29) = -2.94, df = 29, p = .023. Bullying scores were low and not significantly correlated with depressive symptoms, but participants reported more verbal/relational bullying as compared to physical, cultural, or cyberbullying. Cortisol slopes were normal (a negative change) for 20 participants (64.5%), while 4 (12.9%) had a blunted cortisol slope (less than .01 µg/dl change from morning to afternoon) and 7 (22.36%) had an opposite cortisol slope (morning low and afternoon high). Data collection procedures (salivary cortisol and computer-based surveys) were feasible in a school setting. High rates of perceived stress and depressive symptoms warrant a larger study in the future.

Post-deepwater horizon blowout seafood consumption patterns and community-specific levels of concern for selected chemicals among children in Mobile County, Alabama.

PURPOSE: The goal of the study was to characterize risk pertaining to seafood consumption patterns following the Deepwater Horizon oil spill, among school children (K to 4th grade) residing in close proximity to the Gulf of Mexico in Mobile County, Alabama. METHODS: Responses on seafood consumption pattern including the type of seafood and intake rate during the pre and post oil spill periods, from parents of 55 school children from three schools located <20mile radius from the Gulf of Mexico shoreline (coastal group) were compared with those from parents of 55 children from three schools located ≥20miles away from the shoreline (inland group). We also estimated levels of concern (LOCs) in seafood for selected chemicals found in crude oil including heavy metals, and polycyclic aromatic hydrocarbons (PAH), and dioctyl sodium sulfosuccinate (DOSS), the primary compound in dispersants. RESULTS: The coastal group ate more seafood consisting primarily of crustaceans (62% vs. 42%, p=0.04) and fin fish (78% vs. 58%, p=0.02) from the Gulf of Mexico compared to the inland group, while the inland group ate more fin fish not found in the Gulf of Mexico (62% vs. 33%, p<0.01). In the post-oil spill time period, both groups substantially reduced their consumption of sea food. On average, the coastal group ate ≥2 seafood meals per week, while the inland group ate ≤1 meal per week; these frequency patterns persisted in the post oil-spill period. Comparison of the estimated LOCs with contaminant levels detected in the seafood tested by the Food and Drug Administration and National Oceanic and Atmospheric Administration, post-oil spill, found that the levels of PAHs, arsenic, and DOSS in seafood were 1-2 orders of magnitude below the LOCs calculated in our study. Levels of methyl mercury (MeHg) in the seafood tested pre- and post- oil spill were higher than the estimated LOCs suggesting presence of higher levels of MeHg in seafood independent of the oil spill. CONCLUSION: In sum, the study found higher than average seafood consumption among children along the Mobile coastal area when compared to the inland children and the National Health and Nutrition Examination Survey (NHANES) estimates. Risk characterization based on the LOCs indicated no increase in risk of exposure despite higher seafood consumption rates among the study population compared to the general population.

The Roles of Formaldehyde Exposure and Oxidative Stress in Fetal Growth in the Second Trimester.

OBJECTIVE: To examine the relationship between formaldehyde exposure and fetal growth in the second trimester and the potential mediating role of oxidative stress in this relationship. DESIGN: A cross-sectional study was conducted. SETTING: The participants were recruited from one university-related clinic and two private obstetrics and gynecology offices in the Southeastern United States. PARTICIPANTS: A convenience sample of 140 healthy pregnant women in the second trimester of pregnancy was enrolled from November 2013 through June 2014. METHODS: Formaldehyde exposure was measured via vapor monitors worn by the participants for 24 hours. One-time urine samples were collected during a routine prenatal visit to measure the level of 15-isoprostane F2t and cotinine as biomarkers of oxidative stress and tobacco smoking, respectively. Urine creatinine was measured to standardize the cotinine and 15-isoprostane F2t levels. RESULTS: Eighty-eight participants (63%) returned their formaldehyde monitors. The linear regression model showed that the dichotomized level of formaldehyde exposure (<0.03 and >0.03 ppm) was a significant predictor of biparietal diameter percentile after controlling for maternal race (p < .006). The relationship between 15-isoprostane F2t and fetal growth was nonsignificant, and the mediating role of oxidative stress in the relationship between formaldehyde exposure and biparietal diameter was not confirmed. CONCLUSION: A relationship was found between formaldehyde exposure and biparietal diameter in the second trimester. Although further research is necessary to confirm the results of this study, nurses may consider advising pregnant women to limit their exposure to formaldehyde during pregnancy.

Child and Maternal Factors That Influence Child Blood Pressure in Preschool Children: An Exploratory Study.

PURPOSE: Hypertension is a risk factor for cardiovascular disease (CVD) in adults and children and has its origins in childhood. While the prevalence of hypertension in children is estimated to be 2 to 5%, instance elevations in blood pressure readings (BPRs) in school-age children and adolescents are more common, track to adulthood, and are an independent risk factor for CVD. Less information is available about BPR in the preschool period and what child factors could influence those BPR. The primary aims of this exploratory study were to determine child blood pressure (BP) levels and determine effect sizes of the relationships between child and maternal factors that can influence child BP. METHODS: A convenience sample of 15 rural and 15 urban children enrolled in Head Start programs (13 males; 14 females; all black) with ability to understand and speak English and with mothers who gave consent and could understand, read and speak English were enrolled. Mothers completed demographic information about their child including, gender, birth history and age. Height, weight, waist circumference and BP were measured in the mothers and the children. Children gave saliva specimens for cortisol and C-reactive protein. RESULTS: Over 37% of the children had elevated BPR with over 20% at or above the 95th percentile. Effect sizes of relationships ranged from very small to large. CONCLUSION: Elevations in BPR may be seen as early as preschool. It is important to examine factors, both child and maternal that influence BP.

Formaldehyde exposure during pregnancy.

BACKGROUND: Pregnancy is a particularly vulnerable time for exposure to indoor air pollutants, such as formaldehyde (FA), which is linked to spontaneous abortion, congenital malformations, and premature birth. PURPOSE: To determine personal exposure to FA during pregnancy, and to identify the relationship between FA exposure levels and potential residential sources of FA. STUDY DESIGN AND METHODS: The study sample consisted of 140 pregnant women recruited from obstetrical clinics in Huntsville, Alabama. Formaldehyde exposure was measured by FA vapor monitor badges. Questionnaires were administered to participants to identify potential residential sources of FA. Urine cotinine, a surrogate for tobacco smoke exposure, was also used as an indicator of a possible source of residential exposure to FA. RESULTS: The mean level of FA exposure by vapor monitor badge was 0.04 parts per million (ppm) (SD = 0.06; range 0.003-0.54 ppm). Minimum risk levels of 0.03 and higher were found in 36.4% of participants. Exposure levels of FA were higher in spring than winter (p < 0.001). Exposure levels of FA were correlated with indoor temperature of dwellings (p < 0.02), installation of new carpet within last 5 years (p < 0.04), and use of nail polish (p < 0.01). No relationship was found between FA exposure and urine cotinine levels. CLINICAL IMPLICATIONS: Formaldehyde exposure may increase at various times in the lives of women; however, it is of particular concern during pregnancy because of perinatal risk to the exposed fetus.

The relationships among family management behaviors and asthma morbidity in maternal caregivers of children with asthma.

Numerous studies have identified the relationship of the family caregiver's perception regarding asthma management and the child's asthma outcomes, although few have examined family caregiver asthma management behaviors. The primary aim of this study was to examine the relationship among family management behaviors and asthma morbidity as perceived by maternal caregivers. The Family Management Style Framework was used to guide the research. Maternal caregivers (N = 101) with school-aged children diagnosed with persistent asthma and living in the United States were recruited from a specialty asthma clinic. When caregivers perceived they were expending much effort on their child's asthma management and were not confident in their ability to perform management activities, the child's asthma outcomes were worse. This is the first study to examine family management behaviors with maternal caregivers of school-aged children with asthma. Findings from this study encourage health care providers to tailor each educational opportunity with families to improve child asthma outcomes. An ongoing effort must be made to include families in asthma management. Health care partnerships between provider and family can lead to improved asthma management.

Tobacco exposure, weight status, and elevated blood pressure in adolescents.

The pathogenesis of hypertension begins in youth. An estimated 4% of US adolescents have diagnosed hypertension and 17% have elevated blood pressures, predisposing them to hypertension and cardiovascular disease (CVD) later in life. There is limited research on the clustering of CVD risk factors such as tobacco exposure and weight status that may be associated with high blood pressure in adolescents. The aim of this exploratory study was to determine the relationships between total smoke exposure (TSE; cigarette smoking and secondhand smoke), waist circumference, and blood pressure in a sample of rural adolescents, ages 15-18. A convenience sample of 148 adolescents ages 15-18 was recruited from two rural high schools (88 female and 60 male, all Caucasian). Adolescents were assessed for tobacco exposure (self-report, salivary cotinine), weight status (body mass index, waist circumference), and blood pressure. Self-report measures of tobacco exposure included the Uptake Continuum and Peer and Family Smoking measure. Age, gender, waist circumference and salivary cotinine contributed to 35% of the variance in systolic blood pressure and 18% in diastolic blood pressure. One-fourth (25%) of adolescent males and 11% of adolescent females had elevated systolic blood pressures. Approximately one-fifth of the sample (22%) had elevated salivary cotinine levels indicative of tobacco use and secondhand smoke exposure. TSE and waist circumference were predictors of elevated blood pressure in adolescents. Public health measures need to address clusters of risk factors including blood pressure, tobacco exposure, and weight status among adolescents in order to reduce CVD.

Sleep quality, stress, caregiver burden, and quality of life in maternal caregivers of young children with bronchopulmonary dysplasia.

Little is known about the influence of sleep quality, stress, and caregiver burden on quality of life in maternal caregivers of young children with bronchopulmonary dysplasia (BPD). In 61 maternal caregivers (mean age 29.59 years) of young children with BPD (mean age 13.93 months), caregivers reported sleeping a mean of 5.8 hours, and significant correlations were found between sleep quality and depressive symptoms and stress, as well as an inverse correlation with quality of life. Sleep quality was found to be the most significant predictor of quality of life in maternal caregivers.