Effects of Vitamin N Nature Immersion Therapy on Stress Levels in Health Care Workers in the City of Bogotá

Study Overview
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Brief Summary
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Recent studies on health personnel in Colombia have evidenced the considerable increase in the levels of stress and anxiety, among other psychological disorders, as a product of the COVID-19 pandemic that is being experienced since 2019 and that implies a greater demand for attention from the affected citizens, with the consequent work overload and tension due to the risk of contagion. Thus, the present work will allow the generation of new knowledge in relation to the benefits of Vitamin N therapy in Colombia; which can contribute quickly and effectively to the reduction of stress levels, anxiety, insomnia, and depression in individuals, when compared with conventional interventions and result in possible benefits such as the reduction of health problems such as obesity, diabetes, high blood pressure, and diseases associated with the immune system.

Official Title
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Effects of Vitamin N Nature Immersion Therapy on Stress Levels in Health Care Workers in the City of Bogotá: an Intervention Evaluation Study, 2022 - 2024.

Conditions
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Cortisol Excess, Stress, Psychological, Anxiety, Epigenetic Disorder, Natural Killer Cell Cytokine Production, Environmental Exposure

Intervention / Treatment
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* Other: Immersion therapy in nature - Vitamin N


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Persons over 18 years of age Health care workers Prioritized by the psychosocial risk program Complete vaccination schedule for COVID-19 Exclusion Criteria: Undergraduate students in the area of health sciences Pregnant women Allergies or sensitivity to the intervention Workers who consume immunosuppressants or corticosteroids Workers diagnosed with any type of disease or who have undergone chemotherapy or radiotherapy treatment during the last year Persons who have had exposure to X-rays in the last 6 months

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 62 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Parallel intervention evaluation study that will consider two interventions; the conscious immersion therapy in nature (Vitamin N) and the usual intervention designed by the company for psychosocial risk reduction.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Group 1. Regular therapy group<br>Group without intervention during the study period no changes will be made in their daily routine. They will receive a weekly intervention operationalized for psychosocial risk. | |
| Experimental: Group 2A: Vitamin N therapy group - metropolitan park environment<br>Group with periodic outings to a neighborhood or metropolitan natural park (once a week) for approximately 2 hours for a minimum period of six months. | Other: Immersion therapy in nature - Vitamin N<br>* Usual therapy group The first saliva sample will be taken upon awakening to determine cortisol concentration. At their workplace, they will be asked to remain seated and silent for 3 minutes, the following will be taken: blood pressure, heart rate, psychological instruments (stress-anxiety), blood sample. Group 2A and Group 2B In the natural environment, a saliva sample will be taken upon awakening to determine cortisol concentration. After arrival at the site, they will be asked to remain seated and silent for 3 minutes, the following will be taken: blood pressure, heart rate, psychological instruments (stress-anxiety), blood sample. The first phase is a session of observation of the site for 15 minutes. A slow, unhurried walk will be performed for 1 hour and 45 minutes. The order of activities (sitting and walking) will be established to ensure reliability of physiological measurements.<br>* Other names: Shinrin-yoku;|
| Experimental: Group 2B: Vitamin N therapy group - forest forest environment<br>Group with periodic outings to a forest environment (once a week) for a time of approximately 2 hours for a minimum period of six months | Other: Immersion therapy in nature - Vitamin N<br>* Usual therapy group The first saliva sample will be taken upon awakening to determine cortisol concentration. At their workplace, they will be asked to remain seated and silent for 3 minutes, the following will be taken: blood pressure, heart rate, psychological instruments (stress-anxiety), blood sample. Group 2A and Group 2B In the natural environment, a saliva sample will be taken upon awakening to determine cortisol concentration. After arrival at the site, they will be asked to remain seated and silent for 3 minutes, the following will be taken: blood pressure, heart rate, psychological instruments (stress-anxiety), blood sample. The first phase is a session of observation of the site for 15 minutes. A slow, unhurried walk will be performed for 1 hour and 45 minutes. The order of activities (sitting and walking) will be established to ensure reliability of physiological measurements.<br>* Other names: Shinrin-yoku;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Concentration of Cortisol in saliva | Saliva samples from each subject will be obtained with the Salivette device during each day of the intervention. | 1 time per month for 6 months | 
| Outcome Measures in Arterial pressure levels | Blood pressure in mm Hg before and after surgery | 4 time per month for 6 months | 
| Outcome Measures in Heart rate levels | Determination by digital sphygmomanometers | 4 time per month for 6 months | 
| Change Psychological stress measurement scale levels | Determination of a score of the level of occupational stress through different | Three times for 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Natural Killer | Proportion of natural killer cells by flow cytometry. | 1 time per month for 6 months | 
| Beck Anxiety Inventory levels | Determination of a score of the level of anxiety through different items taken into account in this instrument. | Three times for 6 months | 
| NR3C1 and FKBP5 gene methylation. | Percentage of methylation of NR3C1 and FKBP5 genes. | Two times for 6 months | 
| Pittsburgh Sleep Quality levels | Determination of a sleep quality score through different items taken into account in this instrument. | Three times for 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Forest therapy, Nature therapy, Cortisol, Psychological stress, Physiological stress, Anxiety, Blood pressure, Natural Killer, DNA Methylation