Investigation of Stress Situation of Pediatric Nurses and Corresponding Changes of Intestinal Flora

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METHODS: The research take the pediatric nurses in the Third Xiangya Hospital as the research group and the internal medicine nurses as the control group. Use the "Chinese Nurse Stressor Scale"(CNSS) for general investigation and stress-related assessment. 6 in internal medicine group and 7 in pediatric group to conduct cell sequencing of intestinal flora. Gut microbiome was profiled by 16S rRNA sequencing. RESULTS: The work stressors of internal medicine and pediatric nurses includes nursing specialty and work (10.94±3.17 vs 12.25±2.78), work environment and resources (4.91±1.63 vs 5.66±2.03), patient care (15.86±4.30 vs 18.95±5.12) and management and interpersonal relationship (8.83±4.94 vs 10.86±5.01). The results were statistically different (P < 0.05). The abundance of Clostridia in internal medicine group is higher, while the abundance of Bacteroidia in pediatric group is higher. The abundance of γ-proteobacteria and β-proteobacteria also have obvious differences between two groups. CONCLUSIONS: The overall stress score of the pediatric nurse group was higher, with their stool samples having more abundance of Bacteroidia, but Clostridia, γ-Proteobacteria and β-Proteobacteria are fewer than that in internal medicine nurses. Gastroenterology & Hepatology brain-gut axis psychological health work pressure intestinal flora pediatric nurse stressors Figures Figure 1 Figure 2 Figure 3 1 Background With the enforcing of the second-child policy since 2015 in China, the number of infants and children has been increasing, and the overall social attention to the health of children has increased significantly[ 1 ]. However, the number of pediatric nurses in China is relatively small, resulting in the workload of nurses far exceeding the normal standard. This will be accompanied by increased stress concerning career promotion, working quality, work enthusiasm, doctor-patient communication or other aspects[ 2 ]. There are also stressors for pediatric nurses especially in the aspects such as the misunderstanding from anxious parents, the specificity of work in pediatrics and career promotion pressure which decreases the sense of security of nurses[ 3 , 4 ]. Meanwhile, nurses who prepared for pregnancy usually face more psychological pressure than ordinary pregnant women[ 5 ]. Under such pressure, the mental health status of nurses is generally at a terrible stage. Some may even leave the job, indirectly leading to the insufficient staffs and overloaded work among pediatric nurses. In recent years, the relationship between intestinal flora and central nervous system diseases has become a research hotspot[ 6 , 7 ]. Intestinal microorganisms (bacteria, fungi, viruses, etc.) are a total collection of billions of microorganisms residing in the human gastrointestinal tract, of which bacteria contains about 1,000 different species [ 6 , 8 ]. Metagenomic analysis of gastrointestinal bacteria has shown that it contains more than 3 million unique genes, more than 100 times the number of human genes, and formed a very diverse ecosystem[ 9 – 11 ]. Intestinal bacteria enable the growth of metabolically active flora by assisting in the digestion of indigestible compounds (dietary fiber, etc) and maximizing the provision and bioavailability of essential nutrients[ 2 , 12 ]. If intestinal mucosal barrier cells are destroyed, however, a large number of opportunistic pathogens, such as Escherichia coli and enterococcus faecalis , will disrupt the ecological balance of microbial community[ 6 , 13 ]. The brain-gut axis is associated with the pathogenesis of mental illness, with various roles such as regulating immunity, promoting digestion and metabolism, affecting the absorption of fat[ 14 ], and more importantly, an connection between intestinal flora and stress. Studies have suggested that the intestinal flora and brain-gut axis connect the central nervous system (CNS) with the enteric nervous system (ENS) and neuro-endocrine-immune system to form a two-way communication pathway, which regulates gastrointestinal motility function, visceral sensitivity, brain-gut peptide secretion, body responsiveness to stress, and central cognitive function[ 15 ]. So far, there are few studies on intestinal flora and occupation-related stress, especially among pediatric nurses, so this is a topic worthy of attention. In this experiment, for one thing, pediatric nurses were given questionnaires and their stress state was evaluated by scales. For another, their gut flora from stool samples was sequenced to seek for differences. This study aims to pay attention to the physical and mental health of pediatric nurses and analyze the current status of stressors in pediatric nurses. In this way, some corresponding measures can be proposed to improve the working atmosphere of pediatric nurses. 2 Methods 2.1 Participants In this study, we used online survey questionnaires and anonymous submission of questionnaires to conduct pressure-related surveys on pediatric and internal medicine nurses at The Third Xiangya Hospital of Central South University. All participants meet the following criteria: (1) registered nurses registered in The Third Xiangya Hospital;(2) female in good health, not pregnant or lactating; (3) known the project process of this study and been willing to cooperate with the investigation; (4) exclude those who have severe mental illness or have been diagnosed as anxiety disorder or depression anxiety; (5) no related gastrointestinal diseases or recent gastrointestinal symptoms; (6) there were no major family changes or other events that seriously affected the mood of the test subjects recently; (7) the objects have passed the relevant ethical review. (8) exclude who have history of drugs, antibiotics, probiotics or prebiotics taken within 3 months. This study was reviewed and approved by the hospital ethics committee, and informed consent was signed by all nurses investigated. 2.2 Research content 2.2.1 Questionnaire content Chinese nurses' stressors scale was selected for stress-related investigation. This scale investigates 35 questions from five aspects: nursing specialty and work problems, workload and time allocation problems, work environment and resources problems, patient care problems and management and interpersonal relationship problems. Each question is divided into four grades: 0, 1, 2 and 3. The higher the score of the answer is, the more pressure the nurse has. Therefore, the questionnaire we selected is scientific, universal and comprehensive in content coverage. (Supplement1) 2.2.2 Experimental content In order to ensure the randomness of the sample, we selected 35 and 44 nurses by random number table respectively. Fresh feces with 7 internal medicine nurses(in control group) and 6 pediatric nurses(in experimental group) were picked out for sequencing. The sampler intercepts the middle part of the sample, distributes it to a sterilized cryopreservation tube, and stored in a -80 ℃ refrigerator for future use. Total DNA extraction was performed using a QIAamp® DNA Stool Mini Kit (QIAGEN, Tokyo, Japan) according to the manufacturer's instructions. The 16S rDNA sequencing selection region is V1-V2 variable region, and the universal primers used are 27F (5'AGAGTTTGATCCTGGCTCAG-3') and 338R (5'-TGCTGCCTCCCGTAGGAGT-3'). Products amplified by PCR were purified and quantified using the Qubit dsDNA BR Assay Kit. OTU (operational taxonomic units) is a unified mark set for a taxon (strain, genus, species, group, etc.) in the study of phylogeny or population genetics for the convenience of analysis. In order to understand the number of species, genera and other information in the sequencing results of a sample, we need to cluster the sequence. Through the classification operation, the sequences are classified into many groups according to their similarity, each group is an OTU. In general, tags with similarity of more than 97% are clustered into an OTU. Using software usearch(v7.0.1090). Cluster the spliced tags into OTU. The main process is as follows: 1) using uparse to cluster under 97% similarity to get the representative sequence of OTU; 2) using uchime(v4.2.40). The mosaics produced by PCR were removed from the OTU representative sequences (16S compared with the existing mosaics database to remove the mosaics. 18S adopts denovo method to remove the chimera 16S chimera database: golddatabase (v20110519) its chimera database: unite (v201407 03), divided into its full length, ITS1 and ITS2, selected according to sequencing area); 3) using usearch–the global method compares all tags back to the OTU representative sequence, and obtains the OTU abundance statistical table of each sample. PLS-DA analysis (PLS-DA) is a multivariate statistical analysis method for discriminant analysis, which is often used to determine how to classify the research objects. Compared with PCA, PLS-DA method can combine the function of principal component analysis and multiple regression to maximize the interval between components of PCA. That is to say, compared with PCA analysis, the interval between groups in PLS-DA analysis results is larger, and it is easier to see the differences between groups. 2.3 Statistical analysis The subjects filled out questionnaires without giving their names. We summarized the results, entered the data in Excel, and conducted statistical analysis with SPSS 22.0. Quantitative variables are expressed as mean values with standard deviations. Quantitative variables are expressed in Numbers and percentages. T test was used to compare the differences in the total stress scores and the scores of each dimension among nurses in different departments. P value less than or equal to 0.05 was considered statistically significant. 3 Results 3.1 Stressors questionnaire results A total of 35 internal medicine nurses and 44 pediatric nurses participated in the trial. Their basic information and corresponding proportions are described in detail in Table 1. There was a significant difference in the number of years of service between the control group and the experimental group (66% of nurses with more than 10 years of service in internal medicine versus 32% in pediatrics). In addition, the proportion of medical nurses over 30 years old (71%) was higher than that of pediatrics (57%). The proportion of people with educational background and marriage status is relatively consistent. The scores of internal medicine nurses and pediatric nurses in various dimensions of work stressors are shown in Table 2. In terms of nursing specialty and work (10.94 ± 3.17 vs 12.25 ± 2.78), work environment and resources (4.91 ± 1.63 vs 5.66 ± 2.03), patient care (15.86 ± 4.30 vs 18.95 ± 5.12) and management and interpersonal relationship (8.83 ± 4.94 vs 10.86 ± 5.01), there were statistically significant differences between the control group and the experimental group. Meanwhile, the overall score of internal medicine nurses is 50.17 ± 12.13 while pediatric nurses is 57.93 ± 13.01(P < 0.05). The results of the objective factors of nurses' stressors in different departments were further compared, as shown in Table 3. The scores of pediatric nurses who worked for more than 10 years (63.50 ± 13.06) were higher than those of internal medicine nurses (47.96 ± 11.98). The pressure of pediatric nurses over 30 years old (59.56 ± 12.92) was also higher than that of medical nurses (48.72 ± 12.49). The stress score of the highly educated pediatric nurses (59.40 ± 14.20) was higher than that of the internal medicine nurses (45.00 ± 10.65). In addition, the stress of married pediatric nurses (59.18 ± 14.12) was higher than that of internal medicine nurses (50.68 ± 12.81). The results are statistically different( P < 0.05). 3.2 Intestinal flora analysis results 6 nurses selected randomly from internal medicine were set as the control group (group A) while 7 from pediatric were the experimental group (group B) for further analysis by 16S amplification. The structure and abundance of intestinal flora between the two groups showed significant differences. Partial least squares discrimination analysis (PLS-DA) was used to explore the differences in the structure of intestinal flora between groups A and B. The result can be seen in Fig. 1 . Species abundance heat map is a graphical display method of clustering according to the similarity of species or sample abundance by the color gradient representing the relative abundance of species. It can intuitively display the composition and proportion of each sample species, reflecting the changes of species between samples. As can be seen from the figure, the main difference between the two groups exists in Clostridia and Bacteroidia . The abundance of Clostridia in group A is higher than that in group B, whereas Bacteroidia is lower than that in group B. There are also differences in abundance of γ-Proteobacteria and β-Proteobacteria between the two groups(Figs. 2 and 3 ). 4 Discussion It can be clearly seen from the survey results that the overall pressure of pediatric nurses is relatively high higher than internal nurses. It is mainly reflected in nursing specialty, working environment and resources, patient care, management and interpersonal relationship. Working experience, marriage condition and educational background are all factors influencing the stress levels of pediatric nurses. Lupien et al. have shown that nurses experience high levels of test anxiety, state anxiety, and stress, which can be improved after intervention[ 16 ]. Sonia et al. point out that the effects of stress on the brain and behavior in adulthood are reversible and usually disappear when the stressor stops[ 17 ]. Thus, analysis of possible stressors is important to deal with the pressure of pediatric nurse. One of the critical reasons is the particularity of the pediatric nurses. Children have weak immune capacity and insufficient regulatory adaptability because of immature development and imperfect system function[ 18 ]. The disease has the characteristics of rapid onset and rapid development of the disease process and the prognosis is not optimistic, which cause pediatric nurses to have heavy work content, significant responsibility, and greater pressure than internal medicine. Secondly, the second child policy in China in recent years generate a fertility boom, but the number of pediatric staff and the overall scale of pediatrics have not been expanded enough, which has increased the workload of pediatric medical staff. The increasing number of pediatric patients lead to the insufficiency of hospital capacity. Long waiting time for medical consultation and impatience among parents can easily spur conflicts between nurses and patients, or even escalates to the workplace violence[ 19 ]. Studies have shown that emergency and pediatrics are the two most vulnerable departments for nurses to meet violence at work[ 20 ]. Thirdly, in aspects of working environment, pediatric nurses have a low status, low rewards, more onerous work and more complex doctor-patient relationship compared with other departments[ 19 ], which aggravates the loss of personnel of pediatric nurses and makes it more difficult for pediatrics to recruit medical staff. Many hospitals have experienced pediatric "employment shortage". The lack of nursing staff, the heavy workload of nurses and the harsh working environment increase the subjective anxiety and pressure of nurses, leading to the stress among pediatric nurses generally higher than that among internal medicine nurses. A lot more reasons are worthy to consider, and our experiment looks at the problem from a novel perspective. By comparing stool samples from pediatric nurses and internal medicine nurses, we found significant differences in the structure and abundance of intestinal bacteria (Fig. 1 ). Pediatric nurses had lower abundance of H.ammodendron but higher Bacteroides than medical nurses. Meanwhile, the abundances of γ-Proteobacteria and β-Proteobacteria were also varied in the bunch (Fig. 2 , Fig. 3 ). Consistent with this, the analysis of the stress scores did show that the total stress factor scores and four dimensions of pediatric nurses were considerably higher than that of internal medicine nurses, and the differences were statistically significant. This interesting consistency suggests a role for the brain's gut axis. The stress of pediatric nurses is closely related to the psychological effects of work stress. The external stimulation generated by working pressure influences intestinal activities through direct and indirect ways, causing changes in the release of duodenal bicarbonate, hormonal changes, and decreased mucosal immune function[ 21 ], and even intestinal diseases such as intestinal stress syndrome may occur. Enteropathy affects the central nervous system through changes in brain-gut peptide secretion. Anxiety, depression and other emotions of pediatric nurses continue to intensify, forming a vicious circle, and eventually lead to differences in the composition of intestinal bacteria between pediatric nurses and medical staff. Existing studies have shown that biofeedback therapy and behavioral relaxation therapy can improve these symptoms[ 22 ]. Bravo et al. found that probiotics can regulate GABA receptor expression in the cerebral cortex through the vagus nerve, thereby reducing anxiety and depressive behaviors[ 23 ]. Sharon et al. demonstrated that serum 4-ethylphenyl sulfate (4EPS) concentrations were increased in autistic mice, and after treatment with B. fragilis, 4EPS concentrations were decreased and anxiety behaviors were alleviated in mice[ 24 ]. These studies suggest that due to the characteristics of bidirectional communication of the brain-gut axis, it can also act on the central nervous system through the regulation of intestinal bacteria, providing a new therapeutic idea for clinical practice. At the same time, the latest research shows that non-probiotic interventions such as resistant dextrin supplementation can achieve better results, so the effect of dietary restructuring is better than probiotic supplements[ 25 ]. Numerous studies have shown that psycho-psychological factors are closely linked to intestinal motility disorders and visceral sensitivity mechanisms[ 26 ]. Behavior and cognition can affect intestinal activity through indirect complex pathways. After feeling external stimuli, the action pathways of the brain-gut axis on the intestine include indirect pathways and direct pathways. The indirect pathway is through changes in gastrointestinal motility and secretion or changes in intestinal permeability. Direct pathways include the release of signaling molecules into the luminal lamina propria of intestinal cells (cells of enterochromaffin cells, neural cells, immune cells). Changes in intestinal activity, on the other hand, can affect changes in intestinal bacteria. For example, de Magistris's et al. found that autistic patients had increased intestinal mucosal permeability and increased blood concentrations of bacterial lipopolysaccharide (LPS), indicating that brain-gut axis dysfunction can disrupt the intestinal mucosal barrier causing bacterial translocation[ 27 ]. In addition, the brain-gut axis causes irritable bowel syndrome (IBS) under stress conditions. IBS is a common functional bowel disorder which is closely related to the function of brain-gut axis. Since the bidirectional pathway of brain-gut axis also acts on the central nervous system, the generation of IBS will also have adverse effects on the patient's mood. Brilliant et al., after acupuncture and oral treatment of trimebutine maleate tablets in IBS patients, found that while IBS symptoms were relieved, brain-gut peptide secretion such as 5-HT, NPY, and CCRP was reduced, and mental stress was significantly reduced[ 28 ]. As a result, appropriate use of psychological biological agents, antibiotics and other drugs to regulate intestinal flora, through the intestinal and brain axis action to alleviate relatively serious psychological stress (such as anxiety, depression, etc.)[ 9 , 29 , 30 ]. Probiotics and prebiotics can be considered taken in daily work for pediatric nurses so as to moderately supply for reduced intestinal flora. From the perspective of traditional Chinese medicine, proper diet therapy can also improve the type and quantity of intestinal flora. True, merely finding for a curable treatment to reduce psychological stress is a limited approach, which could only treat the symptoms but not the root causes. In view of this situation, pediatric nurses requires an appropriate policy and a better working environment to relieve potential stress. Hospitals should appropriately expand the scale of pediatrics to adapt to the “second-child policy” to ensure the workload of pediatric nurses within acceptable limits. Adopt more diversified management strategies, such as “double night shifts”. Under this policy, both physical need for rest and work effectiveness can be accommodated among the pediatric nurses. Managers could care about nurses such as organizing mindful exchange meetings to eliminate the impact of work stress. For the nurses themselves, improving their professionalism, correctly balancing the relationship between family and work and finding suitable channels for stress relief are also effective ways to relieve stress. 5 Conclusion The psychological stress of pediatric nurses is generally more serious than that of internal medicine nurses due to the surging number of children, large workload, poor working environment and the tension between pediatricians and patients. Considering that intestinal flora and psychological stress may interact through the brain-gut axis, we tested intestinal flora samples from people with high stress. Further analysis of the types and quantities of intestinal flora found that pediatric nurses had more Bacteroidia , but fewer Clostridia, γ-Proteobacteria and β-Proteobacteria than medical nurses. More relevant clinical intervention studies can be carried out to elucidate the relationship between intestinal bacteria regulation and pressure improvement by focusing on the regulation of intestinal bacteria through the non-probiotic pathway in the future. Abbreviations All abbreviations are defined in the manuscript. Declarations Ethics approval and consent to participate: This study was approved by the institutional review board of the Third Xiangya Hospital Central South University (Permission Number: 20020). Consent for publication: Not applicable. Availability of data and material: The data used to support the findings of this study are included within the article. Competing interests: The authors declare no conflict of interest, financial or otherwise. Funding: This study was funded by grants of Natural Science Foundation of Hunan Province, China (grant 2020JJ4864) and National Training Program of Innovation and Entrepreneurship for Undergraduates (2020105330014). Authors' contributions: ZW and BJ conceived of and designed the study and drafted the manuscript. JH and QW performed the literature search and performed the comparison. RS conduct data analysis of questionnaire results. ZC and ZZ generated the figures and tables and performed the background research. JH and JS edited the manuscript. XZ revised the manuscript for important intellectual content. MZ and XZ are responsible for the full text. All authors have read and approved the content of the manuscript. Acknowledgements: None. References Zhao Y, Lin J, Shang X, Yang Q, Wang W, Qiu Y: Impact of the Universal Two-Child Policy on the Workload of Community-Based Basic Public Health Services in Zhejiang Province, China. Int J Environ Res Public Health 2019, 16(16) (1660-4601):2880. Happell B, Dwyer T Fau - Reid-Searl K, Reid-Searl K Fau - Burke KJ, Burke Kj Fau - Caperchione CM, Caperchione Cm Fau - Gaskin CJ, Gaskin CJ: Nurses and stress: recognizing causes and seeking solutions . 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Tables Table 1 Baseline data of participants Department total Age Working years Educational background Marital status 10 Bachelor Master Unmarried Married Internal medicine 35 10(0.29) 25(0.71) 12(0.34) 23(0.66) 26(0.74) 9(0.26) 7(0.20) 28(0.80) Pediatric 44 19(0.43) 25(0.57) 30(0.68) 14(0.32) 34(0.77) 10(0.23) 11(0.25) 33(0.75) Table 2 The score of overall and each dimension Department Number Nursing specialty and work Workload and time allocation Work environment and resources Patient care Management and interpersonal relationship Total score Internal medicine 35 10.94 ± 3.17 9.63 ± 3.18 4.91 ± 1.63 15.86 ± 4.30 8.83 ± 4.94 50.17 ± 12.13 Pediatric 44 12.25 ± 2.78 10.20 ± 2.68 5.66 ± 2.03 18.95 ± 5.12 10.86 ± 5.01 57.93 ± 13.01 P 0.05 < 0.05 < 0.05 < 0.05 0.05 > 10 47.96 ± 11.98 63.50 ± 13.06 < 0.05 Age/ years old 0.05 ≥ 30 48.72 ± 12.49 59.56 ± 12.92 0.05 Master’s degree or above 45.00 ± 10.65 59.40 ± 14.20 0.05 Married 50.68 ± 12.81 59.18 ± 14.12 < 0.05 Supplementary Files supplement1.docx Supplement.1. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-154491","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":8899786,"identity":"091793cb-cca5-4c80-9ed2-c5bb0d267f16","order_by":0,"name":"Zhixiang Wu","email":"","orcid":"","institution":"Central South University Third Xiangya Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhixiang","middleName":"","lastName":"Wu","suffix":""},{"id":8899787,"identity":"4d1fe76a-e83b-43d7-9526-a072731439c9","order_by":1,"name":"Boyue JIANG","email":"","orcid":"","institution":"Central South University Third Xiangya Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Boyue","middleName":"","lastName":"JIANG","suffix":""},{"id":8899788,"identity":"2eaa929e-ee76-41fd-8f42-aa09579561cc","order_by":2,"name":"Xueyan ZHANG","email":"","orcid":"https://orcid.org/0000-0001-6399-7926","institution":"Central South University Third Xiangya Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xueyan","middleName":"","lastName":"ZHANG","suffix":""},{"id":8899789,"identity":"744a2397-3442-4fbc-b2ba-0453e94b4a9b","order_by":3,"name":"Jingyue HAO","email":"","orcid":"","institution":"Central South University Third Xiangya Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jingyue","middleName":"","lastName":"HAO","suffix":""},{"id":8899790,"identity":"2629fac3-ba8d-4168-86ac-e016aaabfff7","order_by":4,"name":"Qingxuan WANG","email":"","orcid":"","institution":"Central South University Third Xiangya Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qingxuan","middleName":"","lastName":"WANG","suffix":""},{"id":8899791,"identity":"77c2f1bc-8c5e-484e-98a2-9851c027c377","order_by":5,"name":"Rubing SHAO","email":"","orcid":"","institution":"Central South University Third Xiangya Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rubing","middleName":"","lastName":"SHAO","suffix":""},{"id":8899792,"identity":"c414c727-3278-4f59-911a-3e95243c2617","order_by":6,"name":"Zengzhen CUI","email":"","orcid":"","institution":"Central South University Third Xiangya Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zengzhen","middleName":"","lastName":"CUI","suffix":""},{"id":8899793,"identity":"dc98660e-c112-412a-bd15-2b34f4885006","order_by":7,"name":"Zhiyuan ZHU","email":"","orcid":"","institution":"Central South University Third Xiangya Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhiyuan","middleName":"","lastName":"ZHU","suffix":""},{"id":8899794,"identity":"939898f1-3270-44fc-bd71-45800148ce61","order_by":8,"name":"Jie SHEN","email":"","orcid":"","institution":"Central South University Third Xiangya Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"SHEN","suffix":""},{"id":8899795,"identity":"7dfd1816-3a34-4aef-9ca5-2ee1f01562f2","order_by":9,"name":"Mingyi ZHAO","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYBACefbGxocf//234ydai2HP4WZjCTbmZMkGovXccG8T4GFjZtxwgFgdjDMY2xgkgHqMjydvYPhRsY2wFnbpxrYHBRI8fGZnnhUw9py5TYQtcw62G0gYSDCb3cgxYGZsI0ILw43ENgmeBAPGzTNI03IggXGDBLFaDHsONhtLNhxIlgD65SBRfpFnb3/48GPDATv+9uSND35UEOMwBEgwOECSerAWUnWMglEwCkbBCAEAqK8+TwcN2mIAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-2884-0736","institution":"Department of Pediatrics, The 3rd Xiangya Hospital of Central South University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mingyi","middleName":"","lastName":"ZHAO","suffix":""}],"badges":[],"createdAt":"2021-01-25 18:49:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-154491/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-154491/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":5388308,"identity":"572f4003-0be4-4a71-9735-3223a6addd3a","added_by":"auto","created_at":"2021-01-29 19:52:16","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":536689,"visible":true,"origin":"","legend":"OTU based PLS-DA analysis\n*PLS-DA is a multivariate statistical analysis method used for discriminant analysis. It can be seen from the figure that the main difference between the two groups A / B exists in Clostridia and Bacteroidia, which have a high proportion. (A: control group, internal medicine nurses; B: experimental group, pediatric nurses)","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-154491/v1/4dcfb6b003e9b44847e1f77b.jpg"},{"id":5388307,"identity":"adb7e08b-d2b7-45c9-9aab-fdc6a9f79204","added_by":"auto","created_at":"2021-01-29 19:52:16","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35188,"visible":true,"origin":"","legend":"The species abundance histogram about relative abundance of different flora.\n*Species abundance histogram can intuitively display the composition and proportion of each sample species, reflecting the changes of species between samples. The abundance of Clostridia in group A is higher than that in group B, and the abundance of Bacteroidia in group B is higher than that in group A. (A: control group, internal medicine nurses; B: experimental group, pediatric nurses)","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-154491/v1/35a58d913883f6f6ef257cd0.jpg"},{"id":5388245,"identity":"b0b0934e-1f39-4840-aecb-ac634e6324ac","added_by":"auto","created_at":"2021-01-29 19:49:16","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":39295,"visible":true,"origin":"","legend":"The Species abundance heat map about relative abundance of different flora.\n*Species abundance heat map is a graphical display method of clustering according to the similarity of species or sample abundance by the color gradient representing the relative abundance of species. (A: control group, internal medicine nurses; B: experimental group, pediatric nurses)","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-154491/v1/2e76636d3623bf77e1eb8af4.jpg"},{"id":18312920,"identity":"337bbfce-97da-4bd3-9b8e-d61034fdc119","added_by":"auto","created_at":"2022-02-17 08:28:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1134610,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-154491/v1/f90ec0e1-8883-41bf-b373-bbfd0ac94a8d.pdf"},{"id":5388246,"identity":"b73c025f-fb4a-445e-a7c0-fa395919b909","added_by":"auto","created_at":"2021-01-29 19:49:16","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15919,"visible":true,"origin":"","legend":"Supplement.1. Job Stresses Scale among Nurses","description":"","filename":"supplement1.docx","url":"https://assets-eu.researchsquare.com/files/rs-154491/v1/8e9c57b418b981bfee760f97.docx"}],"financialInterests":"","formattedTitle":"Investigation of Stress Situation of Pediatric Nurses and Corresponding Changes of Intestinal Flora","fulltext":[{"header":"1 Background","content":" \u003cp\u003eWith the enforcing of the second-child policy since 2015 in China, the number of infants and children has been increasing, and the overall social attention to the health of children has increased significantly[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, the number of pediatric nurses in China is relatively small, resulting in the workload of nurses far exceeding the normal standard. This will be accompanied by increased stress concerning career promotion, working quality, work enthusiasm, doctor-patient communication or other aspects[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. There are also stressors for pediatric nurses especially in the aspects such as the misunderstanding from anxious parents, the specificity of work in pediatrics and career promotion pressure which decreases the sense of security of nurses[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Meanwhile, nurses who prepared for pregnancy usually face more psychological pressure than ordinary pregnant women[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Under such pressure, the mental health status of nurses is generally at a terrible stage. Some may even leave the job, indirectly leading to the insufficient staffs and overloaded work among pediatric nurses.\u003c/p\u003e \u003cp\u003eIn recent years, the relationship between intestinal flora and central nervous system diseases has become a research hotspot[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Intestinal microorganisms (bacteria, fungi, viruses, etc.) are a total collection of billions of microorganisms residing in the human gastrointestinal tract, of which bacteria contains about 1,000 different species [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Metagenomic analysis of gastrointestinal bacteria has shown that it contains more than 3\u0026nbsp;million unique genes, more than 100 times the number of human genes, and formed a very diverse ecosystem[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Intestinal bacteria enable the growth of metabolically active flora by assisting in the digestion of indigestible compounds (dietary fiber, etc) and maximizing the provision and bioavailability of essential nutrients[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. If intestinal mucosal barrier cells are destroyed, however, a large number of opportunistic pathogens, such as \u003cem\u003eEscherichia coli\u003c/em\u003e and \u003cem\u003eenterococcus faecalis\u003c/em\u003e, will disrupt the ecological balance of microbial community[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The brain-gut axis is associated with the pathogenesis of mental illness, with various roles such as regulating immunity, promoting digestion and metabolism, affecting the absorption of fat[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and more importantly, an connection between intestinal flora and stress. Studies have suggested that the intestinal flora and brain-gut axis connect the central nervous system (CNS) with the enteric nervous system (ENS) and neuro-endocrine-immune system to form a two-way communication pathway, which regulates gastrointestinal motility function, visceral sensitivity, brain-gut peptide secretion, body responsiveness to stress, and central cognitive function[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. So far, there are few studies on intestinal flora and occupation-related stress, especially among pediatric nurses, so this is a topic worthy of attention.\u003c/p\u003e \u003cp\u003eIn this experiment, for one thing, pediatric nurses were given questionnaires and their stress state was evaluated by scales. For another, their gut flora from stool samples was sequenced to seek for differences. This study aims to pay attention to the physical and mental health of pediatric nurses and analyze the current status of stressors in pediatric nurses. In this way, some corresponding measures can be proposed to improve the working atmosphere of pediatric nurses.\u003c/p\u003e "},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003e2.1 Participants\u003c/h2\u003e\n\u003cp\u003eIn this study, we used online survey questionnaires and anonymous submission of questionnaires to conduct pressure-related surveys on pediatric and internal medicine nurses at The Third Xiangya Hospital of Central South University. All participants meet the following criteria: (1) registered nurses registered in The Third Xiangya Hospital;(2) female in good health, not pregnant or lactating; (3) known the project process of this study and been willing to cooperate with the investigation; (4) exclude those who have severe mental illness or have been diagnosed as anxiety disorder or depression anxiety; (5) no related gastrointestinal diseases or recent gastrointestinal symptoms; (6) there were no major family changes or other events that seriously affected the mood of the test subjects recently; (7) the objects have passed the relevant ethical review. (8) exclude who have history of drugs, antibiotics, probiotics or prebiotics taken within 3 months. This study was reviewed and approved by the hospital ethics committee, and informed consent was signed by all nurses investigated.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e2.2 Research content\u003c/h2\u003e\n\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n\u003ch2\u003e2.2.1 Questionnaire content\u003c/h2\u003e\n\u003cp\u003eChinese nurses' stressors scale was selected for stress-related investigation. This scale investigates 35 questions from five aspects: nursing specialty and work problems, workload and time allocation problems, work environment and resources problems, patient care problems and management and interpersonal relationship problems. Each question is divided into four grades: 0, 1, 2 and 3. The higher the score of the answer is, the more pressure the nurse has. Therefore, the questionnaire we selected is scientific, universal and comprehensive in content coverage. (Supplement1)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n\u003ch2\u003e2.2.2 Experimental content\u003c/h2\u003e\n\u003cp\u003eIn order to ensure the randomness of the sample, we selected 35 and 44 nurses by random number table respectively. Fresh feces with 7 internal medicine nurses(in control group) and 6 pediatric nurses(in experimental group) were picked out for sequencing. The sampler intercepts the middle part of the sample, distributes it to a sterilized cryopreservation tube, and stored in a -80 ℃ refrigerator for future use. Total DNA extraction was performed using a QIAamp\u0026reg; DNA Stool Mini Kit (QIAGEN, Tokyo, Japan) according to the manufacturer's instructions. The 16S rDNA sequencing selection region is V1-V2 variable region, and the universal primers used are 27F (5'AGAGTTTGATCCTGGCTCAG-3') and 338R (5'-TGCTGCCTCCCGTAGGAGT-3'). Products amplified by PCR were purified and quantified using the Qubit dsDNA BR Assay Kit.\u003c/p\u003e\n\u003cp\u003eOTU (operational taxonomic units) is a unified mark set for a taxon (strain, genus, species, group, etc.) in the study of phylogeny or population genetics for the convenience of analysis. In order to understand the number of species, genera and other information in the sequencing results of a sample, we need to cluster the sequence. Through the classification operation, the sequences are classified into many groups according to their similarity, each group is an OTU. In general, tags with similarity of more than 97% are clustered into an OTU. Using software usearch(v7.0.1090). Cluster the spliced tags into OTU. The main process is as follows: 1) using uparse to cluster under 97% similarity to get the representative sequence of OTU; 2) using uchime(v4.2.40). The mosaics produced by PCR were removed from the OTU representative sequences (16S compared with the existing mosaics database to remove the mosaics. 18S adopts denovo method to remove the chimera 16S chimera database: golddatabase (v20110519) its chimera database: unite (v201407 03), divided into its full length, ITS1 and ITS2, selected according to sequencing area); 3) using usearch\u0026ndash;the global method compares all tags back to the OTU representative sequence, and obtains the OTU abundance statistical table of each sample.\u003c/p\u003e\n\u003cp\u003ePLS-DA analysis (PLS-DA) is a multivariate statistical analysis method for discriminant analysis, which is often used to determine how to classify the research objects. Compared with PCA, PLS-DA method can combine the function of principal component analysis and multiple regression to maximize the interval between components of PCA. That is to say, compared with PCA analysis, the interval between groups in PLS-DA analysis results is larger, and it is easier to see the differences between groups.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e\n\u003cp\u003eThe subjects filled out questionnaires without giving their names. We summarized the results, entered the data in Excel, and conducted statistical analysis with SPSS 22.0. Quantitative variables are expressed as mean values with standard deviations. Quantitative variables are expressed in Numbers and percentages. T test was used to compare the differences in the total stress scores and the scores of each dimension among nurses in different departments. \u003cem\u003eP\u003c/em\u003e value less than or equal to 0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003e3.1 Stressors questionnaire results\u003c/h2\u003e\n\u003cp\u003eA total of 35 internal medicine nurses and 44 pediatric nurses participated in the trial. Their basic information and corresponding proportions are described in detail in Table\u0026nbsp;1. There was a significant difference in the number of years of service between the control group and the experimental group (66% of nurses with more than 10\u0026nbsp;years of service in internal medicine versus 32% in pediatrics). In addition, the proportion of medical nurses over 30\u0026nbsp;years old (71%) was higher than that of pediatrics (57%). The proportion of people with educational background and marriage status is relatively consistent.\u003c/p\u003e\n\u003cp\u003eThe scores of internal medicine nurses and pediatric nurses in various dimensions of work stressors are shown in Table\u0026nbsp;2. In terms of nursing specialty and work (10.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17 vs 12.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78), work environment and resources (4.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63 vs 5.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03), patient care (15.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.30 vs 18.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12) and management and interpersonal relationship (8.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.94 vs 10.86\u0026thinsp;\u0026plusmn;\u0026thinsp;5.01), there were statistically significant differences between the control group and the experimental group. Meanwhile, the overall score of internal medicine nurses is 50.17\u0026thinsp;\u0026plusmn;\u0026thinsp;12.13 while pediatric nurses is 57.93\u0026thinsp;\u0026plusmn;\u0026thinsp;13.01(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eThe results of the objective factors of nurses' stressors in different departments were further compared, as shown in Table\u0026nbsp;3. The scores of pediatric nurses who worked for more than 10\u0026nbsp;years (63.50\u0026thinsp;\u0026plusmn;\u0026thinsp;13.06) were higher than those of internal medicine nurses (47.96\u0026thinsp;\u0026plusmn;\u0026thinsp;11.98). The pressure of pediatric nurses over 30\u0026nbsp;years old (59.56\u0026thinsp;\u0026plusmn;\u0026thinsp;12.92) was also higher than that of medical nurses (48.72\u0026thinsp;\u0026plusmn;\u0026thinsp;12.49). The stress score of the highly educated pediatric nurses (59.40\u0026thinsp;\u0026plusmn;\u0026thinsp;14.20) was higher than that of the internal medicine nurses (45.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.65). In addition, the stress of married pediatric nurses (59.18\u0026thinsp;\u0026plusmn;\u0026thinsp;14.12) was higher than that of internal medicine nurses (50.68\u0026thinsp;\u0026plusmn;\u0026thinsp;12.81). The results are statistically different(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003e3.2 Intestinal flora analysis results\u003c/h2\u003e\n\u003cp\u003e6 nurses selected randomly from internal medicine were set as the control group (group A) while 7 from pediatric were the experimental group (group B) for further analysis by 16S amplification. The structure and abundance of intestinal flora between the two groups showed significant differences. Partial least squares discrimination analysis (PLS-DA) was used to explore the differences in the structure of intestinal flora between groups A and B. The result can be seen in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eSpecies abundance heat map is a graphical display method of clustering according to the similarity of species or sample abundance by the color gradient representing the relative abundance of species. It can intuitively display the composition and proportion of each sample species, reflecting the changes of species between samples. As can be seen from the figure, the main difference between the two groups exists in \u003cem\u003eClostridia\u003c/em\u003e and \u003cem\u003eBacteroidia\u003c/em\u003e. The abundance of \u003cem\u003eClostridia\u003c/em\u003e in group A is higher than that in group B, whereas \u003cem\u003eBacteroidia\u003c/em\u003e is lower than that in group B. There are also differences in abundance of \u003cem\u003e\u0026gamma;-Proteobacteria\u003c/em\u003e and \u003cem\u003e\u0026beta;-Proteobacteria\u003c/em\u003e between the two groups(Figs.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eIt can be clearly seen from the survey results that the overall pressure of pediatric nurses is relatively high higher than internal nurses. It is mainly reflected in nursing specialty, working environment and resources, patient care, management and interpersonal relationship. Working experience, marriage condition and educational background are all factors influencing the stress levels of pediatric nurses. Lupien et al. have shown that nurses experience high levels of test anxiety, state anxiety, and stress, which can be improved after intervention[\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. Sonia et al. point out that the effects of stress on the brain and behavior in adulthood are reversible and usually disappear when the stressor stops[\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. Thus, analysis of possible stressors is important to deal with the pressure of pediatric nurse.\u003c/p\u003e\n\u003cp\u003eOne of the critical reasons is the particularity of the pediatric nurses. Children have weak immune capacity and insufficient regulatory adaptability because of immature development and imperfect system function[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. The disease has the characteristics of rapid onset and rapid development of the disease process and the prognosis is not optimistic, which cause pediatric nurses to have heavy work content, significant responsibility, and greater pressure than internal medicine. Secondly, the second child policy in China in recent years generate a fertility boom, but the number of pediatric staff and the overall scale of pediatrics have not been expanded enough, which has increased the workload of pediatric medical staff. The increasing number of pediatric patients lead to the insufficiency of hospital capacity. Long waiting time for medical consultation and impatience among parents can easily spur conflicts between nurses and patients, or even escalates to the workplace violence[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. Studies have shown that emergency and pediatrics are the two most vulnerable departments for nurses to meet violence at work[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. Thirdly, in aspects of working environment, pediatric nurses have a low status, low rewards, more onerous work and more complex doctor-patient relationship compared with other departments[\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e], which aggravates the loss of personnel of pediatric nurses and makes it more difficult for pediatrics to recruit medical staff. Many hospitals have experienced pediatric \"employment shortage\". The lack of nursing staff, the heavy workload of nurses and the harsh working environment increase the subjective anxiety and pressure of nurses, leading to the stress among pediatric nurses generally higher than that among internal medicine nurses. A lot more reasons are worthy to consider, and our experiment looks at the problem from a novel perspective.\u003c/p\u003e\n\u003cp\u003eBy comparing stool samples from pediatric nurses and internal medicine nurses, we found significant differences in the structure and abundance of intestinal bacteria (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Pediatric nurses had lower abundance of \u003cem\u003eH.ammodendron\u003c/em\u003e but higher \u003cem\u003eBacteroides\u003c/em\u003e than medical nurses. Meanwhile, the abundances of \u003cem\u003e\u0026gamma;-Proteobacteria\u003c/em\u003e and \u003cem\u003e\u0026beta;-Proteobacteria\u003c/em\u003e were also varied in the bunch (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Consistent with this, the analysis of the stress scores did show that the total stress factor scores and four dimensions of pediatric nurses were considerably higher than that of internal medicine nurses, and the differences were statistically significant.\u003c/p\u003e\n\u003cp\u003eThis interesting consistency suggests a role for the brain's gut axis. The stress of pediatric nurses is closely related to the psychological effects of work stress. The external stimulation generated by working pressure influences intestinal activities through direct and indirect ways, causing changes in the release of duodenal bicarbonate, hormonal changes, and decreased mucosal immune function[\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e], and even intestinal diseases such as intestinal stress syndrome may occur. Enteropathy affects the central nervous system through changes in brain-gut peptide secretion. Anxiety, depression and other emotions of pediatric nurses continue to intensify, forming a vicious circle, and eventually lead to differences in the composition of intestinal bacteria between pediatric nurses and medical staff.\u003c/p\u003e\n\u003cp\u003eExisting studies have shown that biofeedback therapy and behavioral relaxation therapy can improve these symptoms[\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. Bravo et al. found that probiotics can regulate GABA receptor expression in the cerebral cortex through the vagus nerve, thereby reducing anxiety and depressive behaviors[\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. Sharon et al. demonstrated that serum 4-ethylphenyl sulfate (4EPS) concentrations were increased in autistic mice, and after treatment with B. fragilis, 4EPS concentrations were decreased and anxiety behaviors were alleviated in mice[\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. These studies suggest that due to the characteristics of bidirectional communication of the brain-gut axis, it can also act on the central nervous system through the regulation of intestinal bacteria, providing a new therapeutic idea for clinical practice. At the same time, the latest research shows that non-probiotic interventions such as resistant dextrin supplementation can achieve better results, so the effect of dietary restructuring is better than probiotic supplements[\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eNumerous studies have shown that psycho-psychological factors are closely linked to intestinal motility disorders and visceral sensitivity mechanisms[\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e]. Behavior and cognition can affect intestinal activity through indirect complex pathways. After feeling external stimuli, the action pathways of the brain-gut axis on the intestine include indirect pathways and direct pathways. The indirect pathway is through changes in gastrointestinal motility and secretion or changes in intestinal permeability. Direct pathways include the release of signaling molecules into the luminal lamina propria of intestinal cells (cells of enterochromaffin cells, neural cells, immune cells). Changes in intestinal activity, on the other hand, can affect changes in intestinal bacteria. For example, de Magistris's et al. found that autistic patients had increased intestinal mucosal permeability and increased blood concentrations of bacterial lipopolysaccharide (LPS), indicating that brain-gut axis dysfunction can disrupt the intestinal mucosal barrier causing bacterial translocation[\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e]. In addition, the brain-gut axis causes irritable bowel syndrome (IBS) under stress conditions. IBS is a common functional bowel disorder which is closely related to the function of brain-gut axis. Since the bidirectional pathway of brain-gut axis also acts on the central nervous system, the generation of IBS will also have adverse effects on the patient's mood. Brilliant et al., after acupuncture and oral treatment of trimebutine maleate tablets in IBS patients, found that while IBS symptoms were relieved, brain-gut peptide secretion such as 5-HT, NPY, and CCRP was reduced, and mental stress was significantly reduced[\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eAs a result, appropriate use of psychological biological agents, antibiotics and other drugs to regulate intestinal flora, through the intestinal and brain axis action to alleviate relatively serious psychological stress (such as anxiety, depression, etc.)[\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]. Probiotics and prebiotics can be considered taken in daily work for pediatric nurses so as to moderately supply for reduced intestinal flora. From the perspective of traditional Chinese medicine, proper diet therapy can also improve the type and quantity of intestinal flora.\u003c/p\u003e\n\u003cp\u003eTrue, merely finding for a curable treatment to reduce psychological stress is a limited approach, which could only treat the symptoms but not the root causes. In view of this situation, pediatric nurses requires an appropriate policy and a better working environment to relieve potential stress. Hospitals should appropriately expand the scale of pediatrics to adapt to the \u0026ldquo;second-child policy\u0026rdquo; to ensure the workload of pediatric nurses within acceptable limits. Adopt more diversified management strategies, such as \u0026ldquo;double night shifts\u0026rdquo;. Under this policy, both physical need for rest and work effectiveness can be accommodated among the pediatric nurses. Managers could care about nurses such as organizing mindful exchange meetings to eliminate the impact of work stress. For the nurses themselves, improving their professionalism, correctly balancing the relationship between family and work and finding suitable channels for stress relief are also effective ways to relieve stress.\u003c/p\u003e"},{"header":"5 Conclusion","content":" \u003cp\u003eThe psychological stress of pediatric nurses is generally more serious than that of internal medicine nurses due to the surging number of children, large workload, poor working environment and the tension between pediatricians and patients. Considering that intestinal flora and psychological stress may interact through the brain-gut axis, we tested intestinal flora samples from people with high stress. Further analysis of the types and quantities of intestinal flora found that pediatric nurses had more \u003cem\u003eBacteroidia\u003c/em\u003e, but fewer \u003cem\u003eClostridia, γ-Proteobacteria\u003c/em\u003e and \u003cem\u003eβ-Proteobacteria\u003c/em\u003e than medical nurses. More relevant clinical intervention studies can be carried out to elucidate the relationship between intestinal bacteria regulation and pressure improvement by focusing on the regulation of intestinal bacteria through the non-probiotic pathway in the future.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eAll abbreviations are defined in the manuscript.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional review board of the Third Xiangya Hospital Central South University (Permission Number: 20020).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to support the findings of this study are included within the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest, financial or otherwise.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by grants of Natural Science Foundation of Hunan Province, China (grant 2020JJ4864) and National Training Program of Innovation and Entrepreneurship for Undergraduates (2020105330014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZW and BJ conceived of and designed the study and drafted the manuscript. JH and QW performed the literature search and performed the comparison. RS conduct data analysis of questionnaire results. ZC and ZZ generated the figures and tables and performed the background research. JH and JS edited the manuscript. XZ revised the manuscript for important intellectual content. MZ and XZ are responsible for the full text. All authors have read and approved the content of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhao Y, Lin J, Shang X, Yang Q, Wang W, Qiu Y: \u003cstrong\u003eImpact of the Universal Two-Child Policy on the Workload of Community-Based Basic Public Health Services in Zhejiang Province, China.\u003c/strong\u003e \u003cem\u003eInt J Environ Res Public Health \u003c/em\u003e2019, \u003cstrong\u003e16(16)\u003c/strong\u003e(1660-4601):2880.\u003c/li\u003e\n\u003cli\u003eHappell B, Dwyer T Fau - Reid-Searl K, Reid-Searl K Fau - Burke KJ, Burke Kj Fau - Caperchione CM, Caperchione Cm Fau - Gaskin CJ, Gaskin CJ: \u003cstrong\u003eNurses and stress: recognizing causes and seeking solutions\u003c/strong\u003e. \u003cem\u003eJ Nurs Manag \u003c/em\u003e2013, \u003cstrong\u003e21(4):638-647. \u003c/strong\u003e(1365-2834 (Electronic)).\u003c/li\u003e\n\u003cli\u003eEwing AE, Carter BS: \u003cstrong\u003eOnce again, Vanderbilt NICU in Nashville leads the way in nurses' emotional support\u003c/strong\u003e. \u003cem\u003ePediatr Nurs \u003c/em\u003e2004, \u003cstrong\u003e30:471-472.\u003c/strong\u003e(0097-9805 (Print)).\u003c/li\u003e\n\u003cli\u003eBraithwaite M: \u003cstrong\u003eNurse burnout and stress in the NICU\u003c/strong\u003e. \u003cem\u003eAdvances in Neonatal Care \u003c/em\u003e2008, \u003cstrong\u003e8(6):343-347.\u003c/strong\u003e(1536-0903 (Print)).\u003c/li\u003e\n\u003cli\u003eAlex MR: \u003cstrong\u003eOccupational hazards for pregnant nurses\u003c/strong\u003e. \u003cem\u003eAmerican Journal of Nursing \u003c/em\u003e2011, \u003cstrong\u003e111(1):28-37\u003c/strong\u003e(1538-7488 (Electronic)).\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eErratum to assessment of a respiratory face mask for capturing air pollutants and pathogens including human influenza and rhinoviruses\u003c/strong\u003e. \u003cem\u003eJ Thorac Dis \u003c/em\u003e2018, \u003cstrong\u003e10\u003c/strong\u003e(8):E676-E677.\u003c/li\u003e\n\u003cli\u003eMalan-Muller S, Valles-Colomer M, Raes J, Lowry CA, Seedat S, Hemmings SMJ: \u003cstrong\u003eThe Gut Microbiome and Mental Health: Implications for Anxiety- and Trauma-Related Disorders\u003c/strong\u003e. \u003cem\u003eOMICS \u003c/em\u003e2018, \u003cstrong\u003e22(2):90‐107\u003c/strong\u003e(1557-8100 (Electronic)).\u003c/li\u003e\n\u003cli\u003eLey RE, Hamady M Fau - Lozupone C, Lozupone C Fau - Turnbaugh PJ, Turnbaugh Pj Fau - Ramey RR, Ramey Rr Fau - Bircher JS, Bircher Js Fau - Schlegel ML, Schlegel Ml Fau - Tucker TA, Tucker Ta Fau - Schrenzel MD, Schrenzel Md Fau - Knight R, Knight R Fau - Gordon JI\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eEvolution of mammals and their gut microbes\u003c/strong\u003e. \u003cem\u003eScience \u003c/em\u003e2008, \u003cstrong\u003e320(5883):1647-51\u003c/strong\u003e(1095-9203 (Electronic)).\u003c/li\u003e\n\u003cli\u003eCepeda MS, Katz EG, Blacketer C: \u003cstrong\u003eMicrobiome-Gut-Brain Axis: Probiotics and Their Association With Depression\u003c/strong\u003e. \u003cem\u003eJ Neuropsychiatry Clin Neurosci \u003c/em\u003e2017, \u003cstrong\u003e29(1):39-44. \u003c/strong\u003e(1545-7222 (Electronic)).\u003c/li\u003e\n\u003cli\u003eSender R, Fuchs S, Milo R: \u003cstrong\u003eAre We Really Vastly Outnumbered? 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North Am \u003c/em\u003e2017, \u003cstrong\u003e46(1):77-89.\u003c/strong\u003e(1558-1942 (Electronic)).\u003c/li\u003e\n\u003cli\u003ede Magistris L, Familiari V Fau - Pascotto A, Pascotto A Fau - Sapone A, Sapone A Fau - Frolli A, Frolli A Fau - Iardino P, Iardino P Fau - Carteni M, Carteni M Fau - De Rosa M, De Rosa M Fau - Francavilla R, Francavilla R Fau - Riegler G, Riegler G Fau - Militerni R\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eAlterations of the intestinal barrier in patients with autism spectrum disorders and in their first-degree relatives\u003c/strong\u003e. \u003cem\u003eJournal of Pediatric Gastroenterology and Nutrition \u003c/em\u003e2010, \u003cstrong\u003e51(4):418-24\u003c/strong\u003e(1536-4801 (Electronic)).\u003c/li\u003e\n\u003cli\u003eLacy BE, Nicandro JP, Chuang E, Earnest DL: \u003cstrong\u003eAlosetron use in clinical practice: significant improvement in irritable bowel syndrome symptoms evaluated using the US Food and Drug Administration composite endpoint\u003c/strong\u003e. \u003cem\u003eTherap Adv Gastroenterol \u003c/em\u003e2018, \u003cstrong\u003e11:1756284818771674.\u003c/strong\u003e(1756-283X (Print)).\u003c/li\u003e\n\u003cli\u003eOsadchiy V, Martin CR, Mayer EA: \u003cstrong\u003eThe Gut-Brain Axis and the Microbiome: Mechanisms and Clinical Implications\u003c/strong\u003e. \u003cem\u003eClin Gastroenterol Hepatol \u003c/em\u003e2019, \u003cstrong\u003e17(2):322-332. \u003c/strong\u003e(1542-7714 (Electronic)).\u003c/li\u003e\n\u003cli\u003eMartin CR, Osadchiy V, Kalani A, Mayer EA: \u003cstrong\u003eThe Brain-Gut-Microbiome Axis\u003c/strong\u003e.\u003cem\u003e Cell Mol Gastroenterol Hepatol \u003c/em\u003e2018, \u003cstrong\u003e6(2):133-148. \u003c/strong\u003e(2352-345X (Print)).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cp\u003eTable 1\u003c/p\u003e\n\u003cp\u003eBaseline data of participants\u003c/p\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDepartment\u003c/div\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003etotal\u003c/div\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eWorking years\u003c/div\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eEducational background\u003c/div\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMarital status\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;30\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026ge;\u0026thinsp;30\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026le;\u0026thinsp;10\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026gt; 10\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eBachelor\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMaster\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUnmarried\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMarried\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eInternal medicine\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10(0.29)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e25(0.71)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e12(0.34)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e23(0.66)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e26(0.74)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e9(0.26)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e7(0.20)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e28(0.80)\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePediatric\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e44\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e19(0.43)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e25(0.57)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e30(0.68)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e14(0.32)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e34(0.77)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10(0.23)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e11(0.25)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e33(0.75)\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tabb\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cp\u003eTable 2\u003c/p\u003e\n\u003cp\u003eThe score of overall and each dimension\u003c/p\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDepartment\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNumber\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNursing specialty and work\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eWorkload and\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003etime allocation\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eWork environment\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eand resources\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePatient care\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eManagement and interpersonal relationship\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTotal score\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eInternal medicine\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10.94\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e9.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.18\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e15.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.30\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e8.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.94\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e50.17\u0026thinsp;\u0026plusmn;\u0026thinsp;12.13\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePediatric\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e44\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e12.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e5.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.03\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e18.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10.86\u0026thinsp;\u0026plusmn;\u0026thinsp;5.01\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e57.93\u0026thinsp;\u0026plusmn;\u0026thinsp;13.01\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003eP\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt; 0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026gt; 0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tabc\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cp\u003eTable 3\u003c/p\u003e\n\u003cp\u003eComparison of objective factors of stressors\u003c/p\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDepartment\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eInternal medicine\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePediatric\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Italic\"\u003eP\u003c/span\u003e\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eWorking years\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026le;\u0026thinsp;10\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e54.42\u0026thinsp;\u0026plusmn;\u0026thinsp;11.74\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e54.75\u0026thinsp;\u0026plusmn;\u0026thinsp;12.08\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026nbsp;10\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e47.96\u0026thinsp;\u0026plusmn;\u0026thinsp;11.98\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e63.50\u0026thinsp;\u0026plusmn;\u0026thinsp;13.06\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge/ years old\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;30\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e53.80\u0026thinsp;\u0026plusmn;\u0026thinsp;10.92\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e55.79\u0026thinsp;\u0026plusmn;\u0026thinsp;13.16\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026ge;\u0026thinsp;30\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e48.72\u0026thinsp;\u0026plusmn;\u0026thinsp;12.49\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e59.56\u0026thinsp;\u0026plusmn;\u0026thinsp;12.92\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eEducational background\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eBachelor\u0026rsquo;s degree\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e51.65\u0026thinsp;\u0026plusmn;\u0026thinsp;12.53\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e56.53\u0026thinsp;\u0026plusmn;\u0026thinsp;12.34\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMaster\u0026rsquo;s degree or above\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e45.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.65\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e59.40\u0026thinsp;\u0026plusmn;\u0026thinsp;14.20\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMarital status\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUnmarried\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e48.14\u0026thinsp;\u0026plusmn;\u0026thinsp;9.44\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e54.18\u0026thinsp;\u0026plusmn;\u0026thinsp;8.32\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMarried\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e50.68\u0026thinsp;\u0026plusmn;\u0026thinsp;12.81\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e59.18\u0026thinsp;\u0026plusmn;\u0026thinsp;14.12\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026nbsp;0.05\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"brain-gut axis, psychological health, work pressure, intestinal flora, pediatric nurse, stressors","lastPublishedDoi":"10.21203/rs.3.rs-154491/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-154491/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBACKGROUND: Sequencing the stool samples to explore the relationship between intestinal flora and the stressor of nurses. \u003c/p\u003e\u003cp\u003eMETHODS: The research take the pediatric nurses in the Third Xiangya Hospital as the research group and the internal medicine nurses as the control group. Use the \"Chinese Nurse Stressor Scale\"(CNSS) for general investigation and stress-related assessment. 6 in internal medicine group and 7 in pediatric group to conduct cell sequencing of intestinal flora. Gut microbiome was profiled by 16S rRNA sequencing. \u003c/p\u003e\u003cp\u003eRESULTS: The work stressors of internal medicine and pediatric nurses includes nursing specialty and work (10.94±3.17 vs 12.25±2.78), work environment and resources (4.91±1.63 vs 5.66±2.03), patient care (15.86±4.30 vs 18.95±5.12) and management and interpersonal relationship (8.83±4.94 vs 10.86±5.01). The results were statistically different (P \u0026lt; 0.05). The abundance of \u003cem\u003eClostridia\u003c/em\u003e in internal medicine group is higher, while the abundance of \u003cem\u003eBacteroidia\u003c/em\u003e in pediatric group is higher. The abundance of \u003cem\u003eγ-proteobacteria\u003c/em\u003e and \u003cem\u003eβ-proteobacteria\u003c/em\u003e also have obvious differences between two groups.\u003c/p\u003e\u003cp\u003eCONCLUSIONS: The overall stress score of the pediatric nurse group was higher, with their stool samples having more abundance of \u003cem\u003eBacteroidia,\u003c/em\u003e but \u003cem\u003eClostridia, γ-Proteobacteria\u003c/em\u003e and \u003cem\u003eβ-Proteobacteria\u003c/em\u003e are fewer than that in internal medicine nurses.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Investigation of Stress Situation of Pediatric Nurses and Corresponding Changes of Intestinal Flora","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-01-29 19:49:15","doi":"10.21203/rs.3.rs-154491/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ca72e29-d2bf-491f-9e27-0953445c198a","owner":[],"postedDate":"January 29th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":2114335,"name":"Gastroenterology \u0026 Hepatology"}],"tags":[],"updatedAt":"2022-02-17T08:28:24+00:00","versionOfRecord":[],"versionCreatedAt":"2021-01-29 19:49:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-154491","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-154491","identity":"rs-154491","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}