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Aims: Microvascular dysfunction has been proposed to drive heart failure with preserved ejection fraction (HFpEF), but the initiating molecular and cellular events are largely unknown. Our objective was to determine when microvascular alterations in HFpEF begin, how they contribute to disease progression, and how pericyte dysfunction plays a role herein., Methods and Results: Microvascular dysfunction, characterized by inflammatory activation, loss of junctional barrier function, and altered pericyte-endothelial crosstalk, was assessed with respect to the development of cardiac dysfunction, in the Zucker fatty and spontaneously hypertensive (ZSF1) obese rat model of HFpEF at three time points: 6, 14, and 21 weeks of age. Pericyte loss was the earliest and strongest microvascular change, occurring before prominent echocardiographic signs of diastolic dysfunction were present. Pericytes were shown to be less proliferative and had a disrupted morphology at 14 weeks in the obese ZSF1 animals, who also exhibited an increased capillary luminal diameter and disrupted endothelial junctions. Microvascular dysfunction was also studied in a mouse model of chronic reduction in capillary pericyte coverage ( PDGF-B ret/ret ), which spontaneously developed many aspects of diastolic dysfunction. Pericytes exposed to oxidative stress in vitro showed downregulation of cell cycle-associated pathways and induced a pro-inflammatory state in endothelial cells upon co-culture., Conclusion: We propose pericytes are important for maintaining endothelial cell function, where loss of pericytes enhances the reactivity of endothelial cells to inflammatory signals and promotes microvascular dysfunction, thereby accelerating the development of HFpEF., Competing Interests: Conflict of interest: None., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Aims: Viral myocarditis (VM) is an inflammatory pathology of the myocardium triggered by a viral infection that may cause sudden death or heart failure (HF), especially in the younger population. Current treatments only stabilize and improve cardiac function without resolving the underlying inflammatory cause. The factors that induce VM to progress to HF are still uncertain, but neutrophils have been increasingly associated with the negative evolution of cardiac pathologies. The present study investigates the contribution of neutrophils to VM disease progression in different ways., Methods and Results: In a coxsackievirus B3- (CVB3) induced mouse model of VM, neutrophils and neutrophil extracellular traps (NETs) were prominent in the acute phase of VM as revealed by enzyme-linked immunosorbent assay analysis and immunostaining. Anti-Ly6G-mediated neutrophil blockade starting at model induction decreased cardiac necrosis and leucocyte infiltration, preventing monocyte and Ly6CHigh pro-inflammatory macrophage recruitment. Furthermore, genetic peptidylarginine deiminase 4-dependent NET blockade reduced cardiac damage and leucocyte recruitment, significantly decreasing cardiac monocyte and macrophage presence. Depleting neutrophils with anti-Ly6G antibodies at 7 days post-infection, after the acute phase, did not decrease cardiac inflammation., Conclusion: Collectively, these results indicate that the repression of neutrophils and the related NET response in the acute phase of VM improves the pathological phenotype by reducing cardiac inflammation., Competing Interests: Conflict of interest: S.H. receives personal fees for scientific advice to Astra-Zeneca, Cellprothera, CSL Behring, and Merck; unrestricted research grant from Pfizer. K.M. has received consulting fees for scientific advice to PEEL Therapeutics. All the remaining authors, P.C., L.F.G., S.V.B., V.S., D.D.G., N.G., and E.A.V.J., declare no competing interests., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Recovered COVID-19 patients often display cardiac dysfunction, even after a mild infection. Most current histological results come from patients that are hospitalized and therefore represent more severe outcomes than most COVID-19 patients face. To overcome this limitation, we investigated the cardiac effects of SARS-CoV-2 infection in a hamster model. SARS-CoV-2 infected hamsters developed diastolic dysfunction after recovering from COVID-19. Histologically, increased cardiomyocyte size was present at the peak of viral load and remained at all time points investigated. As this increase is too rapid for hypertrophic remodeling, we found instead that the heart was oedemic. Moreover, cardiomyocyte swelling is associated with the presence of ischemia. Fibrin-rich microthrombi and pericyte loss were observed at the peak of viral load, resulting in increased HIF1α in cardiomyocytes. Surprisingly, SARS-CoV-2 infection inhibited the translocation of HIF1α to the nucleus both in hamster hearts, in cultured cardiomyocytes, as well as in an epithelial cell line. We propose that the observed diastolic dysfunction is the consequence of cardiac oedema, downstream of microvascular cardiac ischemia. Additionally, our data suggest that inhibition of HIF1α translocation could contribute to an exaggerated response upon SARS-CoV-2 infection., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Daems, Liesenborghs, Boudewijns, Simmonds, Kraisin, Van Wauwe, Cuijpers, Raman, Geuens, Buyten, Lox, Verhamme, Van Linthout, Martinod, Heymans, Tschöpe, Neyts and Jones.)

Aim: To evaluate the impact and the possible role of psychological resilience in the COVID-19 pandemic outbreak on healthcare workers' mental and physical well-being in Belgium., Design: This cross-sectional, survey-based study enrolled 1376 healthcare workers across Belgium from 17 April 2020 to 24 April 2020., Methods: The study sample consisted of direct care workers (nurses and doctors), supporting staff and management staff members. The main outcomes are resilience, distress and somatization., Results: Higher educational level was associated with lower symptoms of distress and somatization. Physicians exhibited the lowest risk of experiencing heightened levels of distress and somatization. Controlling for confounding factors, higher levels of resilience were associated with a 12% reduced chance of increased distress levels and 5% lower chance of increased somatization levels. Our results suggest the potentially buffering role of mental resilience on those working on the frontline during the COVID-19 pandemic outbreak., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: The multitude of negative consequences of nurse burnout calls for interventions to protect the well-being of the individual nurses, patients, and hospital organizations. However, much is still to be discovered about the development of this complex psychological syndrome., Purpose: This study aimed to describe the development of nurse burnout for a population of Flemish hospital nurses while considering vulnerability and situational stressors as indicated by the vulnerability-stress model., Methods: Ten registered nurses were enlisted for semistructured interviews through purposive sampling. All selected nurses were currently suffering from burnout, showed a burnout risk, or had gone through a burnout in the past. A descriptive thematic analysis was performed with themes inductively emerging from the data., Results: Four main themes emerged: "being passionate about doing well or being good," "teamwork," "manager," and "work and personal circumstances." More specifically, it was the discrepancy between the first individual vulnerability factor and the three situational stressors that led to feelings of stress and burnout., Conclusions: The essence of the development of nurse burnout was found in the discrepancy between individual vulnerability and situational stressors. Therefore, we recommend burnout prevention to target both factors.

Stress has become an inherent aspect of the nursing profession. Chronically experienced work stress can lead to burnout. Although situational stressors show a significant influence on burnout, their power to predict the complete syndrome is rather limited. After all, stressors only exist "in the eye of the beholder". This study aimed to explore how individual vulnerability factors such as core-self evaluations and coping, contribute to burnout in relation to situational stressors within a population of hospital nurses. Cross-sectional data was collected in 2014, using five validated self-report instruments: Dutch Core Self Evaluations Scale, Nursing Work Index Revised, Utrecht Coping List, Ruminative Response Scale, and Utrecht Burnout Scale. 219 of the 250 questionnaires were returned. Core-self evaluations, situational factors and coping each contributed significantly to the predictive capacity of the models of the separate burnout dimensions. Core-self evaluations was significantly related to emotional exhaustion. It was suggested that Core-self evaluations might be placed at the initiation of the loss cycle. However, further research is warranted., Competing Interests: The authors have declared that no competing interests exist.

Aims and Objectives: To study the combination of personality and interpersonal behaviour of staff nurses in general hospitals in relation to burnout and its separate dimensions., Background: More research on the individual factors contributing to the development of burnout is needed to improve the risk profile of nursing staff. Therefore, a combination of Leary's interpersonal circumplex model, which depicts the interpersonal behaviour trait domain, and the five-factor model was considered in the study at hand., Design: A cross-sectional research method was applied using self-report questionnaires., Methods: A total of 880 Belgian general hospital nurses were invited to participate in the study. Data were collected from November 2012-July 2013. The questionnaire consisted of three validated self-report instruments: the NEO five-factor inventory, the Dutch Interpersonal Behaviour Scale and the Maslach Burnout Inventory., Results: Of the 880 nurses invited to participate, 587 (67%) returned the questionnaire. Sex, neuroticism, submissive-friendly behaviour, dominant-friendly behaviour and vector length were found to be predictive factors for emotional exhaustion. For depersonalisation, sex, neuroticism, conscientiousness, friendly behaviour, submissive-friendly behaviour, dominant-hostile behaviour and vector length were predictive factors. Finally, personal accomplishment was determined by neuroticism, openness, conscientiousness, and hostile behaviour., Conclusions: This study confirmed the influence of the Big Five personality factors on the separate dimensions of burnout. Interpersonal behaviour made a significant contribution to the predictive capacity of the regression models of all three dimensions of burnout. Additional longitudinal research is required to confirm the causal relationship between these individual factors and burnout., Relevance to Clinical Practice: The results of this study can help to achieve a better understanding of which vulnerabilities an individual prevention programme for burnout should target. In addition, hospitals could use assessment instruments to identify nurses who are prone to burnout and thus would benefit from additional support or stress reduction programmes., (© 2017 John Wiley & Sons Ltd.)

Organisational and work-related challenges faced by midwives make them vulnerable to burnout, but individual factors, such as interpersonal behaviour, can also contribute. A study in eight hospitals in the Dutch-speaking part of Belgium investigated the prevalence of burnout among Flemish midwives, assessed their interpersonal behaviour, and explored the relationship between interpersonal behaviour, burnout, job satisfaction and intention to leave. This article describes the study and reports the findings.