Impaired Glycolysis Promotes AlcoholExposure-Induced Apoptosis in HEI-OC1 Cells via Inhibition of EGFR Signaling.

Glucose metabolism is an important metabolic pathway in the auditory system. Chronic alcohol exposure can cause metabolic dysfunction in auditory cells during hearing loss. While alcohol exposure has been linked to hearing loss, the mechanism by which impaired glycolysis promotes cytotoxicity and cell death in auditory cells remains unclear. Here, we show that the inhibition of epidermal growth factor receptor (EGFR)-induced glycolysis is a critical mechanism for alcohol exposure-induced apoptosis in HEI-OC1 cells. The cytotoxicity via apoptosis was significantly increased by alcohol exposure in HEI-OC1 cells. The glycolytic activity and the levels of hexokinase 1 (HK1) were significantly suppressed by alcohol exposure in HEI-OC1 cells. Mechanistic studies showed that the levels of EGFR and AKT phosphorylation were reduced by alcohol exposure in HEI-OC1 cells. Notably, HK1 expression and glycolytic activity was suppressed by EGFR inhibition in HEI-OC1 cells. These results suggest that impaired glycolysis promotes alcohol exposure-induced apoptosis in HEI-OC1 cells via the inhibition of EGFR signaling.

Cisplatin-Induced Ototoxicity in Rats Is Driven by RIP3-Dependent Necroptosis.

Cisplatin-induced early-onset ototoxicity is linked to hearing loss. The mechanism by which cisplatin causes ototoxicity remains unclear. The purpose of this study was to identify the involvement of receptor-interacting protein kinase (RIP)3-dependent necroptosis in cisplatin-induced ototoxicity in vitro and in vivo. Sprague-Dawley rats (SD, 8 week) were treated via intraperitoneal (i.p.) injection with cisplatin (16 mg/kg for 1 day), and their hearing thresholds were measured by the auditory brainstem response (ABR) method. Hematoxylin and eosin (H & E) staining, immunohistochemistry, and western blots were performed to determine the effect of cisplatin-induced ototoxicity on cochlear morphology. Inhibitor experiments with necrostatin 1 (Nec-1) and Z-VAD were also performed in HEI-OC1 cell line. H&E stains revealed that the necroptotic changes were increased in the organ of Corti (OC) and spiral ganglion neurons (SGNs). Moreover, immunohistochemistry and western blot analysis showed that cisplatin treatment increased the protein levels of RIP3 in both OCs and SGNs. The treatment of Nec-1, a selective RIP1 inhibitor, resulted in markedly suppression of cisplatin-induced cell death in HEI-OC1 cells, whereas Z-VAD treatment did not change the cisplatin-induced cell death. Our results suggest that RIP3-dependent necroptosis was substantial in cisplatin-induced ototoxicity; inner cochlear regions, the OCs, and SGNs were especially sensitive to necroptosis.

Current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination: an expert Delphi survey among dental hygienists.

PURPOSE: This study aimed to investigate current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination (KDHNLE) through an expert Delphi survey. METHODS: A Delphi survey was conducted from May through August 2016 in Korea. This Delphi survey included 20 persons representing the field of dental hygiene (7 groups from various dental hygiene-related organizations). The Delphi survey was administered through e-mail as 3 rounds of questionnaire surveys regarding the issues facing the KDHNLE and potential solutions to those challenges. The primary Delphi survey was an open questionnaire. In each round, subjects' responses were categorized according to the detailed themes of their responses. The minimum value of the content validity ratio of the survey results was determined by the number of panels participating in the Delphi survey. RESULTS: Issues facing the KDHNLE were identified from the results of the Delphi survey. The following 4 items had an average importance score of 4.0 or higher and were considered as important by over 85% of the panels: the failure of the practical test to reflect actual clinical settings, the focus of the practical test on dental scaling, the gap between the items evaluated on the national examination and actual practical work, and insufficiency in strengthening the expertise of licensed dental hygienists. The following items were suggested for improvement: more rigorous rater training, adjustment of the difficulty of the licensing examination, the introduction of a specialized dental hygienist system, and more rigorous refresher training for licensed dental hygienists. CONCLUSION: Based on the above results, the KDHNLE should be improved according to the core competencies of dental hygienists, including on-site clinical practice experience.

Sirt1 Regulates DNA Methylation and Differentiation Potential of Embryonic Stem Cells by Antagonizing Dnmt3l.

Embryonic stem cell (ESC) abnormalities in genome methylation hamper the utility of their therapeutic derivatives; however, the underlying mechanisms are unknown. Here, we show that the nicotinamide adenine dinucleotide (NAD)-dependent deacetylase, Sirt1, selectively prevents abnormal DNA methylation of some developmental genes in murine ESCs by antagonizing Dnmt3l. Transcriptome and DNA methylome analyses demonstrated that Sirt1-null (Sirt1-/-) ESCs repress expression of a subset of imprinted and germline genes concomitant with increased DNA methylation of regulatory elements. Dnmt3l was highly expressed in Sirt1-/- ESCs, and knockdown partially rescued abnormal DNA methylation of the Sirt1 target genes. The Sirt1 protein suppressed transcription of Dnmt3l and physically interacted with the Dnmt3l protein, deacetylating and destabilizing Dnmt3l protein. Sirt1 deficiency delayed neurogenesis and spermatogenesis. These differentiation delays were significantly or partially abolished by reintroduction of Sirt1 cDNA or Dnmt3l knockdown. This study sheds light on mechanisms that restrain DNA methylation of developmentally vital genes operating in ESCs.

Subject-Object Asymmetry in the Second Language Acquisition of English Relatives and Embedded Wh-Questions.

This study examined subject-object asymmetry and developmental sequence in the second language (L2) acquisition of three types of wh-extraction, i.e., English headed relatives, headless relatives, and embedded wh-questions. Sixty-four L1 Korean learners of English completed an elicited imitation task and a grammaticality judgment task. The learners demonstrated a subject advantage in the headed RCs and headless RCs, but an object advantage in the embedded wh-questions, which suggests that they treat embedded wh-questions differently from headed relatives and headless relatives despite the similarities in surface forms. The learners further demonstrated the order of developing headless RCs followed by embedded wh-questions, and subsequently headed RCs, which supports the primacy of headless relatives as a simple nominal in L2 development.

Mesenchymal Stem Cell Therapy Alleviates Interstitial Cystitis by Activating Wnt Signaling Pathway.

Interstitial cystitis (IC) is a syndrome characterized by urinary urgency, frequency, pelvic pain, and nocturia in the absence of bacterial infection or identifiable pathology. IC is a devastating disease that certainly decreases quality of life. However, the causes of IC remain unknown and no effective treatments or cures have been developed. This study evaluated the therapeutic potency of using human umbilical cord-blood-derived mesenchymal stem cells (UCB-MSCs) to treat IC in a rat model and to investigate its responsible molecular mechanism. IC was induced in 10-week-old female Sprague-Dawley rats via the instillation of 0.1 M HCl or phosphate-buffered saline (PBS; sham). After 1 week, human UCB-MSC (IC+MSC) or PBS (IC) was directly injected into the submucosal layer of the bladder. A single injection of human UCB-MSCs significantly attenuated the irregular and decreased voiding interval in the IC group. Accordingly, denudation of the epithelium and increased inflammatory responses, mast cell infiltration, neurofilament production, and angiogenesis observed in the IC bladders were prevented in the IC+MSC group. The injected UCB-MSCs successfully engrafted to the stromal and epithelial tissues and activated Wnt signaling cascade. Interference with Wnt and epidermal growth factor receptor activity by small molecules abrogated the benefits of MSC therapy. This is the first report that provides an experimental evidence of the therapeutic effects and molecular mechanisms of MSC therapy to IC using an orthodox rat animal model. Our findings not only provide the basis for clinical trials of MSC therapy to IC but also advance our understanding of IC pathophysiology.

The Therapeutic Effects of Human Mesenchymal Stem Cells Primed with Sphingosine-1 Phosphate on Pulmonary Artery Hypertension.

Stem cell (SC) therapy has become a potential treatment modality for pulmonary artery hypertension (PAH), but the efficacy of human SC and priming effects have not yet been established. The mobilization and homing of hematopoietic stem cells (HSCs) are modulated by priming factors that include a bioactive lipid, sphingosine-1-phosphate (S1P), which stimulates CXCR4 receptor kinase signaling. Here, we show that priming human mesenchymal stem cells (MSCs) with S1P enhances their therapeutic efficacy in PAH. Human MSCs, similar to HSCs, showed stronger chemoattraction to S1P in transwell assays. Concomitantly, MSCs treated with 0.2 µM S1P showed increased phosphorylation of both MAPKp42/44 and AKT protein compared with nonprimed MSCs. Furthermore, S1P-primed MSCs potentiated colony forming unit-fibroblast, anti-inflammatory, and angiogenic activities of MSCs in culture. In a PAH animal model induced by subcutaneously injected monocrotaline, administration of human cord blood-derived MSCs (hCB-MSCs) or S1P-primed cells significantly attenuated the elevated right ventricular systolic pressure. Notably, S1P-primed CB-MSCs, but not unprimed hCB-MSCs, also elicited a significant reduction in the right ventricular weight ratio and pulmonary vascular wall thickness. S1P-primed MSCs enhanced the expression of several genes responsible for stem cell trafficking and angiogenesis, increasing the density of blood vessels in the damaged lungs. Thus, this study demonstrates that human MSCs have potential utility for the treatment of PAH, and that S1P priming increases the effects of SC therapy by enhancing cardiac and vascular remodeling. By optimizing this protocol in future studies, SC therapy might form a basis for clinical trials to treat human PAH.

The molecular nature of very small embryonic-like stem cells in adult tissues.

Pluripotent stem cells (PSCs) have been considered as the most important cells in regenerative medicine as they are able to differentiate into all types of cells in the human body. PSCs have been established from several sources of embryo tissue or by reprogramming of terminally differentiated adult tissue by transduction of so-called Yamanaka factors (Oct4, Sox2, Klf4, and cMyc). Interestingly, accumulating evidence has demonstrated the residence of PSCs in adult tissue and with the ability to differentiate into multiple types of tissue-committed stem cells (TCSCs). We also recently demonstrated that a population of pluripotent Oct4(+) SSEA-1(+)Sca-1(+)Lin(-)CD45(-) very small embryonic-like stem cells (VSELs) resides in the adult murine bone marrow (BM) and in other murine tissue. These very small (∼3-6 µm) cells express pluripotent markers such as Oct4, Nanog, and SSEA-1. VSELs could be specified into several tissue-residing TCSCs in response to tissue/organ injury, and thus suggesting that these cells have a physiological role in the rejuvenation of a pool of TCSCs under steady-state conditions. In this review article, we discuss the molecular nature of the rare population of VSELs which have a crucial role in regulating the pluripotency, proliferation, differentiation, and aging of these cells.

Isolation and characterization of novel microsatellite markers for the northern mauxia shrimp, Acetes chinensis, using pyrosequencing.

Among the 14 species in the Acetes genus, Acetes japonicus and Acetes chinensis, are the only and also abundant two species around the Korean Peninsula, and are used in traditional recipes. These species are of great economic importance, but little is known about their population genetics, despite the fact that information of this kind is important for stock assessment, fisheries management and identification of origin. A total of 9 microsatellite (MS) markers for A. chinensis were developed using pyrosequencing techniques. Polymorphisms of these markers were evaluated in 96 wild individuals collected from the Yellow Sea off the coast of Korea. A total of 133 alleles were detected at nine loci, with a cross-species transferability of 56% with A. japonicus. These markers will facilitate assessment of population genetic diversity in the genus Acetes.

Endoplasmic reticulum stress activates transglutaminase 2 leading to protein aggregation.

Aberrant activation of transglutaminase 2 (TGase2) contributes to a variety of protein conformational disorders such as neurodegenerative diseases and age-related cataracts. The accumulation of improperly folded proteins in the endoplasmic reticulum (ER) triggers the unfolded protein response (UPR), which promotes either repair or degradation of the damaged proteins. Inadequate UPR results in protein aggregation that may contribute to the development of age-related degenerative diseases. TGase2 is a calcium-dependent enzyme that irreversibly modifies proteins by forming cross-linked protein aggregates. Intracellular TGase2 is activated by oxidative stress which generates large quantities of unfolded proteins. However, the relationship between TGase2 activity and UPR has not yet been established. In the present study, we demonstrated that ER stress activated TGase2 in various cell types. TGase2 activation was dependent on the ER stress-induced increase in the intracellular calcium ion concentration but not on the TGase2 protein expression level. Enzyme substrate analysis revealed that TGase2-mediated protein modification promoted protein aggregation concurrently with decreasing water solubility. Moreover, treatment with KCC009, a TGase2 inhibitor, abrogated ER stress-induced TGase2 activation and subsequent protein aggregation. However, TGase2 activation had no effect on ER stress-induced cell death. These results demonstrate that the accumulation of misfolded proteins activates TGase2, which further accelerates the formation of protein aggregates. Therefore, we suggest that inhibition of TGase2 may be a novel strategy by which to prevent the protein aggregation in age-related degenerative diseases.

The paracrine effects of mesenchymal stem cells stimulate the regeneration capacity of endogenous stem cells in the repair of a bladder-outlet-obstruction-induced overactive bladder.

Overactive bladder (OAB), which is characterized by the sudden and uncomfortable need to urinate with or without urinary leakage, is a challenging urological condition. The insufficient efficacy of current pharmacotherapies that uses antimuscarinic agents has increased the demand for novel long-term/stable therapeutic strategies. Here, we report the superior therapeutic efficacy of using mesenchymal stem cells (MSCs) for the treatment of OAB and a novel therapeutic mechanism that activates endogenous Oct4(+) primitive stem cells. We induced OAB using bladder-outlet-obstruction (BOO) in a rat model and either administered a single transplantation of human adipose-derived MSCs or daily intravenous injections of solifenacin, an antimuscarinic agent, for 2 weeks. Within 2 weeks, both the MSC- and solifenacin-treated groups similarly demonstrated relief from BOO-induced detrusor overactivity, hypertrophic smooth muscle, and neurological injuries. In contrast with the solifenacin-treated groups, a single transplantation of MSCs improved most OAB parameters to normal levels within 4 weeks. Although the transplanted human MSCs were hardly engrafted into the damaged bladders, the bladder tissues transplanted with MSCs increased rat sequence-specific transcription of Oct4, Sox2, and Stella, which are surrogate markers for primitive pluripotent stem cells. In addition, MSCs enhanced the expression of several genes, responsible for stem cell trafficking, including SDF-1/CXCR4, HGF/cMet, PDGF/PDGFR, and VEGF/VEGFR signaling axis. These changes in gene expression were not observed in the solifenacin-treated group. Therefore, we suggest the novel mechanisms for the paracrine effect of MSCs as unleashing/mobilizing primitive endogenous stem cells, which could not only explain the long-term/stable therapeutic efficacy of MSCs, but also provide promising new therapies for the treatment of OAB.

Genome-wide analysis of murine bone marrow­derived very small embryonic-like stem cells reveals that mitogenic growth factor signaling pathways play a crucial role in the quiescence and ageing of these cells.

It has been postulated that the most primitive population of stem cells, Oct4(+)Sca-1(+)Lin(-)CD45(-) very small embryonic-like stem cells (VSELs), differentiate into tissue-committed stem cells in adult mice. However, Oct4(+) VSELs remain quiescent in adult tissues and do not form teratomas. In thi study, we report the characteristics of the VSEL transcriptome by gene set enrichment analysis employing a microarray database established from 20 murine bone marrow-derived, FACS-sorted VSELs in comparison with hematopoietic stem cells and embryonic stem cells. In the Oct4(+) VSELs, we observed the upregulation of tissue-specific gene sets and a gene set encoding the complement-coagulation cascade. By contrast, in the VSELs, we observed the downregulation of genes involved in the UV radiation response, mRNA processing and mitogenic growth factor signaling [e.g., insulin-like growth factor­1 (IGF-1) and neurotrophic tyrosine kinase receptor A (TRKA), as well as the ERK and PI3K pathways]. Employing leading-edge subset analysis and real-time PCR assays, we observed that several genes, such as growth factor receptor-bound protein 2 (Grb2), son of sevenless homolog 1 (Sos1), SHC (Src homology 2 domain containing) transforming protein 1 (Shc1), mitogen-activated protein kinase kinase 1 (Map2k1), v-akt murine thymoma viral oncogene homolog 3 (Akt3), Elk1, ribosomal protein S6 kinase, 90 kDa, polypeptide 3 (Rps6kA3), glycogen synthase kinase 3ß (Gsk3ß) and casein kinase 2, alpha 1 polypeptide (Csnk2A1), which are involved in mitogenic growth factor signaling pathways, were commonly downregulated in the VSELs. Notably, this repression was reversed in the VSELs co-cultured over a C2C12 supportive cell-line, whereby they are induced to form VSEL-derived spheres (VSEL-DSs); thus, they are enriched, forming more differentiated stem cells. Therefore, we suggest that the repression of mitogenic growth factor signaling (e.g., through the IGF-1 receptor) may prevent uncontrolled Oct4(+) VSEL proliferation and teratoma formation. Thus, restoring the responsiveness to mitogenic growth factors may be a crucial step in employing these cells in regenerative medicine.

Characterizations of Shell and Mantle Edge Pigmentation of a Pacific Oyster, Crassostrea gigas, in Korean Peninsula.

The objectives of this study were to investigate color patterns of shell and mantle edge pigmentation of a Pacific oyster, C. gigas, and to estimate variance components of the two colors. A sample of 240 F0 oysters was collected from six aquaculture farms in Tongyeong, Korea to measure shell color and mantle edge pigmentation. Among the F0s, male and female individuals with black (white) shell and black (white) mantle edge were selected and mated to generate three F1 full-sib black (white) cross families (N = 265). Two and four F2 cross families (N = 286) were also produced from black and white F1 selected individuals, respectively. Variance component estimates due to residuals and families within color were obtained using SAS PROC VARCOMP procedures to estimate heritability of shell and mantle edge pigmentation. In the F0 generation, about 29% (11%) had black (white) color for both shell and mantle edge. However, in the F1 and F2 black (white) cross families, 75% (67%) and 100% (100%) of oysters had black (white) shell colors, and 59% (23%) and 79% (55%) had black (white) mantle edge, respectively. Spearman correlation coefficients between shell and mantle edge color were 0.25, 0.74, and 0.92 in F0, F1, and F2 generations, respectively, indicating that, with generations of selection process, an individual with black (white) shell color is more likely to have black (white) mantle edge pigmentation. This suggests that shell color could be a good indicator trait for mantle edge pigmentation if selection of both the colors is implemented for a couple of generations. Estimates of heritability were 0.41 and 0.77 for shell color and 0.27 and 0.08 for mantle edge pigmentation in the F1 and F2 generations, respectively, indicating that, in general, significant proportions of phenotypic variations for the shell and mantle edge colors are explained by genetic variations between individuals. These results suggest that the two color traits are inheritable and correlated, enabling effective selection on shell and mantle edge color.

Analysis of mutations and the association between polymorphisms in the cerebral dopamine neurotrophic factor (CDNF) gene and Parkinson disease.

Neurotrophic factors support the survival of dopaminergic neurons. The cerebral dopamine neurotrophic factor (CDNF) is a novel neurotrophic factor with strong trophic activity on dopaminergic neurons comparable to that of glial cell line-derived neurotrophic factor (GDNF). To investigate whether rare or common variants in CDNF are associated with Parkinson disease (PD), we performed mutation analysis of CDNF and a genetic association study between CDNF polymorphisms and PD. We screened 110 early-onset Parkinson disease (EOPD) patients for CDNF mutations. Allelic and genotype frequencies of 3 CDNF single nucleotide polymorphisms (SNPs) (rs1901650, rs7094179, and rs11259365) were compared in 215 PD patients and age- and sex-matched controls. We failed to identify any mutations in CDNF among the EOPD patient sample population. We observed a trend towards increased risk for PD in patients carrying the C allele of SNP rs7094179 (odds ratio (OR)=1.27, 95% confidence interval (CI) 0.96-1.67). Patients carrying the C allele were susceptible to PD in both dominant (CC+CA vs. AA; OR=7.20, 95% CI 0.88-59.1) and recessive (CA+AA vs. CC; OR=0.64, 95% CI 0.41-0.99) models. Genotype and allele frequencies of SNPs rs1901650 and rs11259365 did not differ between PD patients and controls. Our study suggests that the C allele of an intronic CDNF SNP (rs7094179) might be an allele for susceptibility to PD. Further studies with larger sample size are required to confirm our results.

An international comparison of Korean and Chinese nursing students with nursing curricula and educational outcomes.

AIM: The aim of this study was to compare Korean and Chinese nursing students with respect to their nursing curricula and educational outcomes including critical thinking, professionalism, leadership, communication skills, and nursing practice skills. METHODS: Data were collected from 762 nursing college students (355 in Korea and 407 in China) using the validated self-report questionnaires. The instruments were translated into Chinese for the Chinese students. FINDINGS: Korea offered various nursing courses more focused on specific nursing compared to China. With respect to critical thinking skills, the Korean students had significantly higher scores than the Chinese students. The Chinese students had significantly higher scores than the Korean students on the professionalism and communication skills. There were no differences between the groups in scores of leadership and nursing practice skills. CONCLUSION AND RECOMMENDATIONS: This study provides preliminary information on cross-national nursing educational outcomes. A comparison of educational outcomes among nursing students of other countries as well as China will determine differences in nursing educational outcomes that the nursing program is located in, and an international flow of students through the nursing educational should develop a general direction for nursing education.

[Evaluation of the Korean formal educational program for training care workers for frail elderly].

PURPOSE: This study was done to evaluate the formal education program provided by the Korean government for care workers for frail elderly people. METHODS: This study was a cross-sectional survey in which 438 certified care workers who had completed the education program participated. Data were collected from June to October 2009, using a self-report questionnaire consisting of satisfaction with, and understanding of the education program. RESULTS: The participants had a mean age of 46.7 yr, 87.9% were female and 58.2% were high school graduates. For the theory part of the education, the highest score for understanding was for'supporting household & activities of daily living' while the lowest score for understanding was for'care for death and dying'. For the practical education, the highest score for understanding was for'talking with the client' and the lowest score was for'first aid & basic life support'. There was a significant difference in satisfaction and understanding of the theoretical and practical parts according to educational level. CONCLUSION: Continuing education programs are needed for care workers for elders, both in the theoretical and practical areas. Also the content of programs should address the weak points of this formal education program.

Evaluation of the completeness of the nursing process for patients having gastrectomy using electronic nursing records.

The purpose of this study was to evaluate recording completeness of the nursing process. We compared nursing statements documented at the time when the Electronic Nursing Record (ENR) system, based on the ICNP, was implemented in 2004 with those documented in 2007. The ENRs for 35 gastrectomy patients in each year were selected for evaluation. The selected data were 11,822 nursing statements in 2004 and 27,870 in 2007. The results indicated a significant increase in the completeness of the nursing process in 2007. In addition, the number of nursing diagnosis increased by 5.1 times. The most contributing factor for this increase is assumed to be nurse education.

The effects of a weight loss program focusing on maternal education on childhood obesity.

PURPOSE: Childhood obesity is a matter of great concern because of its negative health and social consequences. We examined the effect of a weight control program focusing on maternal education on childhood obesity, given that the incidence of obesity is greatly affected by parents. METHODS: A two-group pre-test/post-test design was used. Participants consisted of 65 obese children and their mothers. The children were fourth- to sixth-grade elementary students who did not currently receive any therapy for weight loss. The children and their mothers were randomly assigned to either an experimental (n = 32) or a control group (n = 33). The 8-week intervention for mothers included one-time group education, three-time phone counseling, and four-time fliers regarding obesity management. Four outcomes (self-control, obesity index, abdominal circumference, and body fat percentage) were measured before and after the intervention. Chi-squared test or t test was used to test homogeneity between the two groups. Analysis of covariance was used to test the intervention effects. RESULTS: After the intervention was completed, the level of self-control was significantly heightened and obesity levels in the other three outcomes were greatly lowered in the experimental group when compared with the control group. CONCLUSION: Due to strong maternal effects on children's weight control, mothers' active participation must be encouraged in order to resolve childhood obesity.

[Effects of a self-help group program for young adults with hemophilia].

PURPOSE: The purpose of this study was to identify the effects of Self-help program for Young adults with hemophilia. METHOD: A quasi-experimental design was used. The subjects were 40 young adults with hemophilia, 21 in the experimental group and 19 in the control group. The subjects of the experimental group participated in a self-help group program for five sessions for 5 weeks. The program consisted of health education about hemophilia, exercise, and therapeutic recreation. Its outcomes were evaluated on self-efficacy, ADL, depression, and quality of life. The obtained data was analyzed using the Mann-Whitney U test of SPSS. RESULT: 1) The scores of self-efficacy, ADL and quality of life increased significantly in the experimental group as compared to the control group. 2) The score of depression decreased significantly in the experimental group as compared to the control group. CONCLUSION: Considering these research results, the program is effective in improving self-management ability and quality of life. Therefore this program could be implemented as a self-help group program for hemophilia clients.

[Adjustment patterns of illness process of people with hemophilia in Korea].

PURPOSE: The purpose of this study was to explore adjustment pattern of illness process of people with hemophilia in Korea. METHOD: 23 people with hemophilia had participated for this study. The data were collected through in-depth interviews and analyzed using Strauss & Corbin's grounded theory method. RESULT: "would be free from" was emerged as a core category and it reflects that all participants wanted to be free from the constraints of the disease. The adjustment process was categorized into two stage, the 'unstable stage' and the 'stable stage'. In the process of "would be free from" four different patterns were identified: hopelessness type; appreciation type; challenge type; and transcendence type. These types were identified based on the degree of pursuing normal life and managing the disease, and social support. The most frequently occurring type was hopelessness type but the participants of this type suffered the most. The transcendence type was the most ideal type, but it occurred the least. CONCLUSION: The results of this study indicate that people with hemophilia in Korea still suffer from the disease and they need supports. The results would be useful for health care professionals in establishing education and counseling program for the people with hemophilia.