Lifestyle Factors Influencing Metabolic Syndrome after Adjusting for Socioeconomic Status and Female Reproductive Health Indicators: A National Representative Survey in Korean Pre- and Postmenopausal Women.

Metabolic syndrome (MetS) is increasing markedly among postmenopausal women. Although studies suggest multiple risk factors for its development, few have investigated changes in socioeconomic status (SES), female reproductive health indicators (menarche age, experience of pregnancy, delivery, breastfeeding, and postmenopausal status), and lifestyle factors. This study investigated lifestyle factors affecting MetS prevalence among pre- and post-menopausal women after adjusting for SES and female reproductive health indicators. Data from the Korea National Health and Nutrition Examination Survey VII (2016-2018) on 2856 pre- and postmenopausal women aged 40-59 years were analyzed. Differences in SES (e.g., age, education, and household income), female reproductive health indicators (e.g., age of menarche and menopause), and lifestyle (e.g., total calorie intake, fats, and proteins, percentage of energy from carbohydrates, fats, and proteins, smoking, physical activity, and obesity) between MetS and non-MetS groups were calculated by performing χ2 or t-tests. Consequently, current smoking, physical inactivity, overweight, and obesity were significantly associated with increased MetS after adjusting for SES and female reproductive health indicators using logistic regression analysis. Hence, health policies and programs focusing on modifiable MetS risk factors-encouraging healthy eating habits, smoking cessation, and regular exercise-must be formulated to prevent the development of MetS in pre- and postmenopausal women.

Experiences of Nursing Instructors Related to Safety Issues Using Students as Practice Models in Laboratories: A Focus Group Study.

AIM: Nursing school students perform invasive (i.e., injection, venipuncture) and/or non-invasive procedures (i.e., giving a bed bath and back massage) on each other to master these skills, and nursing instructors reported related safety issues. This study aimed to explore nursing instructors' experiences concerning their students' psychological and physical safety when using students as practice models in nursing skills laboratories. METHODS: A qualitative design using focus group interviews and thematic analysis was employed. Two semi-structured focus group interviews were conducted with a purposive sample of eight instructors with experience in teaching nursing skills in laboratories. This study was evaluated by the Institutional Review Board at Eulji University (EU18-51) in the Republic of Korea. RESULTS: Three main themes emerged to describe nursing instructors' safety-related experiences when using students as practice models in nursing skills laboratories: (1) a dilemma between the experimental learning of students and the need to keep students safe, (2) perception related to psychological safety, and (3) an inadequate safety reporting system. CONCLUSIONS: When instructors consider using students' bodies to practice nursing skills, they experience a dilemma between the students' experimental learning and the need to keep them safe. Thus, methods to maximize student learning and student safety guidelines should be developed.

Biomechanical Comparison of Multilevel Lumbar Instrumented Fusions in Adult Spinal Deformity According to the Upper and Lower Fusion Levels: A Finite Element Analysis.

Multilevel lumbar fusion with posterior pedicle screw fixation is a widely performed surgical procedure for the management of adult spinal deformity. However, there has not been a comprehensive biomechanical study on the different types of fusion levels in terms of stability and possible complications. We aimed to investigate the biomechanical properties of multilevel lumbar fusion according to different types of upper and lower fusion levels. Six different types of fusions were performed using three-dimensional finite element models. Type A and B referred to the group of which upper fusion level was L1 and T10, respectively. Subtype 1, 2, and 3 referred to the group of which lower fusion level was L5, S1, and ilium, respectively (A1, L1-L5; A2, L1-S1; A3, L1-ilium; B1, T10-L5; B2, T10-S1; B3, T10-ilium). Flexion, extension, axial rotation, and lateral bending moments were applied, and the risk of screw loosening and failure and adjacent segment degeneration (ASD) was analyzed. Stress at the bone-screw interface of type B3 was lowest in overall motions. The risk of screw failure showed increasing pattern as the upper and lower levels extended in all motions. Proximal range of motion (ROM) increased as the lower fusion level changed from L5 to S1 and the ilium. For axial rotation, type B3 showed higher proximal ROM (16.2°) than type A3 (11.8°). In multilevel lumbar fusion surgery for adult spinal deformity, adding iliac screws and increasing the fusion level to T10-ilium may lower the risk of screw loosening. In terms of screw failure and proximal ASD, however, T10-ilium fusion has a higher potential risk compared with other fusion types. These results will contribute for surgeons to provide adequate patient education regarding screw failure and proximal ASD, when performing multilevel lumbar fusion.

Optical Fluorescence Imaging of Native Proteins Using a Fluorescent Probe with a Cell-Membrane-Permeable Carboxyl Group.

Although various methods for selective protein tagging have been established, their ap plications are limited by the low fluorescent tagging efficiency of specific terminal regions of the native proteins of interest (NPIs). In this study, the highly sensitive fluorescence imaging of single NPIs was demonstrated using a eukaryotic translation mechanism involving a free carboxyl group of a cell-permeable fluorescent dye. In living cells, the carboxyl group of cell-permeable fluorescent dyes reacted with the lysine residues of acceptor peptides (AP or AVI-Tag). Genetically encoded recognition demonstrated that the efficiency of fluorescence labeling was nearly 100%. Nickel-nitrilotriacetic acid (Ni-NTA) beads bound efficiently to a single NPI for detection in a cell without purification. Our labeling approach satisfied the necessary conditions for measuring fluorescently labeled NPI using universal carboxyl fluorescent dyes. This approach is expected to be useful for resolving complex biological/ecological issues and robust single-molecule analyses of dynamic processes, in addition to applications in ultra-sensitive NPIs detection using nanotechnology.

Effect of self-care intervention for controlling interdialytic weight gain among patients on haemodialysis: A systematic review and meta-analysis.

AIMS AND OBJECTIVES: This study aims to identify the combined effects of self-care or self-management nursing interventions on primary (interdialytic weight gain) and secondary (potassium, phosphorous, self-care and self-efficacy) outcomes in haemodialysis patients with chronic kidney disease. BACKGROUND: Prior systematic reviews and meta-analyses revealed inconclusive evidence regarding the effects of self-care or self-management nursing interventions among the patients on haemodialysis. Also, insufficient or unclear descriptions of methods resulted in weak empirical evidence of such effects. DESIGN: Systematic review and meta-analysis were used. METHODS: Four databases were searched to identify 36 articles published from 2000 to 2020. Keywords were selected according to the Population Intervention Comparison Outcome format using MeSH terms and text words. The meta-analysis involved synthesis of effect size, tests of homogeneity and heterogeneity, and funnel plot, Egger's regression test, and Begg's test for assessing publication bias. This study was performed based on the Guidelines of Systematic Reporting of Examination presented in the PRISMA checklist (Appendix S1) and the Cochrane Handbook for Systematic Reviews of Interventions. The search protocol has been registered at the PROSPERO International Prospective Register of Systematic Reviews. RESULTS: The overall effect on interdialytic weight gain was -0.26, suggesting a small effect size, with the interdialytic weight gain after nursing interventions decreasing significantly. Among the type of nursing interventions, the overall effect on interdialytic weight gain of education programmes and fluid and sodium control programmes was -0.36 and 0.25, respectively, a small effect size, and was statistically significant. CONCLUSIONS: Based on the results of this study, healthcare professionals may encourage the patients on haemodialysis to engage in self-directed management of their symptoms, such as health contract, and promote health literacy through improving their self-efficacy. RELEVANCE TO CLINICAL PRACTICE: This meta-analysis could provide fundamental data to assist with the development of an evidence-based practice guideline.

Factors associated with teaching efficacy among nurse educators in hospital settings.

AIMS AND OBJECTIVES: The objective of this study was to examine differences in personal characteristics, core practice competency and role stress according to levels of teaching efficacy among clinical nurse educators working in general hospitals. BACKGROUND: In the clinical setting, successful adaptation to instruction among practicing clinical nurse educators is challenging. DESIGN: Secondary analysis of data through a cross-sectional study design was adopted. METHODS: Originally, 565 nurses were recruited from general hospitals; 364 were included in this study. Participants were nurses with more than 1 year of experience in various settings from 16 general hospitals wherein nursing students trained for clinical practicum in five cities in South Korea. Self-reported data were collected via the Teaching Efficacy, Core Practice Competency and Perceived Stress Scales assessing clinical education-related teaching efficacy, core practice competency and role stress. In the analyses, comparison between nurses with high and low teaching efficacy was conducted. We have followed through the EQUATOR (e.g. STROBE) research checklist for the preparation of this manuscript. RESULTS: According to univariate analysis, levels of teaching efficacy were shown to be higher with age, longer clinical careers, in those undergoing a doctoral course or with a doctorate, previous experience in providing clinical education and enrolment in continuing education for clinical education. In the multivariate analysis, enrolment in continuing education for clinical education, assessment and intervention skills, critical thinking skills, teaching skills and role ambiguity were associated with level of teaching efficacy among nurse educators. CONCLUSION: Based on the results of this study, we recommend that nursing administrators should foster the recognition of personal characteristics in potential clinical nurse educators or preceptors with high teaching efficacy. RELEVANCE TO CLINICAL PRACTICE: Nurses should be supported by providing them with opportunities for professional development to enhance teaching efficacy.

Coping Processes of Patients with Ostomies in South Korea: A Focus Group Study.

Despite the adverse effects of negative coping after receiving a stoma, there is a lack of information on how patients cope with ostomies and on their families' experiences throughout the coping process. We aimed to explore the coping experiences of individuals with ostomies throughout their illness, applying the Corbin and Strauss Chronic Illness Trajectory Framework, using exploratory qualitative methods involving focus group interviews. Purposive sampling was utilized to recruit 19 participants (split across three groups) through an ostomy association in South Korea. Two focus group interviews were separately conducted from March through to May 2017 until data saturation was achieved. Using qualitative content analysis, we analyzed the transcribed interviews and identified words and themes to interpret the results. The coping experiences of patients with ostomies were expressed through three interrelated themes: struggling and suffering, learning how to live with ostomy, and living with ostomy. We found gender differences in spousal support and a struggle among older patients regarding social coping. The themes identified suggest that gender should be considered when designing interventions to help patients cope with ostomies.

Depression-like behaviors induced by defective PTPRT activity through dysregulated synaptic functions and neurogenesis.

PTPRT has been known to regulate synaptic formation and dendritic arborization of hippocampal neurons. PTPRT-/- null and PTPRT-D401A mutant mice displayed enhanced depression-like behaviors compared with wild-type mice. Transient knockdown of PTPRT in the dentate gyrus enhanced the depression-like behaviors of wild-type mice, whereas rescued expression of PTPRT ameliorated the behaviors of PTPRT-null mice. Chronic stress exposure reduced expression of PTPRT in the hippocampus of mice. In PTPRT-deficient mice the expression of GluR2 (also known as GRIA2) was attenuated as a consequence of dysregulated tyrosine phosphorylation, and the long-term potentiation at perforant-dentate gyrus synapses was augmented. The inhibitory synaptic transmission of the dentate gyrus and hippocampal GABA concentration were reduced in PTPRT-deficient mice. In addition, the hippocampal expression of GABA transporter GAT3 (also known as SLC6A11) was decreased, and its tyrosine phosphorylation was increased in PTPRT-deficient mice. PTPRT-deficient mice displayed reduced numbers and neurite length of newborn granule cells in the dentate gyrus and had attenuated neurogenic ability of embryonic hippocampal neural stem cells. In conclusion, our findings show that the physiological roles of PTPRT in hippocampal neurogenesis, as well as synaptic functions, are involved in the pathogenesis of depressive disorder.

Anxiety of Older Persons Living Alone in the Community.

Anxiety is a common mental health problem among older persons, and the prevalence is higher in those who live alone than those who live with others. This study aimed to explore the experiences of anxiety in older persons living alone. A descriptive phenomenological approach was used to collect and analyze the interview data from 15 older persons (5 males, 10 females) living alone in Seoul, South Korea. Four main themes emerged from the data analysis: fear of being alone, concern about having an aged body, apprehension mixed with depression and loneliness, and fear of economic difficulties. These findings indicate that older persons living alone should receive continuous attention to prevent them from being neglected and their anxiety from worsening. Above all, it is vital to ensure comprehensive support for older persons living alone to alleviate their anxiety.

A Concept Analysis of Traditional Korean (Hanbang) Nursing.

PURPOSE: The purpose of this concept analysis was to clarify the meaning and the attributes of traditional Korean (Hanbang) nursing. DATA SOURCE: Data sources include Academic Search Complete, Allied and Complementary Medicine Database, EBSCOhost, PubMed, MEDLINE, and Research Information Sharing Service. DATA SYNTHESIS: We used Walker and Avant's method to analyze the concept of Hanbang nursing. CONCLUSIONS: By exploring its common use in the literature, a comprehensive definition of the concept of Hanbang nursing was developed. IMPLICATIONS FOR NURSING PRACTICE: The results of analyzing the current concept of Hanbang nursing will help provide a better understanding of it and contribute to expanding nursing knowledge and developing of a valid and reliable measurement.

Age Differences in the Coping Strategies of Patients With Colorectal Cancer.

BACKGROUND: Colon and/or rectum cancer (CRC) patients use various strategies to cope with their condition, and these can vary between age groups. OBJECTIVES: The aims of this study were to investigate differences between psychosocial/spiritual variables and coping strategies in CRC patients of different age groups (younger vs older) and to identify the predictors of coping for both age groups. METHODS: A cross-sectional descriptive study was conducted at 3 outpatient clinics in Korea. The Hospital Anxiety and Depression Scale, Social Support Scale, and Self-Transcendence Scale were used to measure psychosocial and spiritual variables; the Mini-Mental Adjustment to Cancer Scale was used to assess cancer-specific coping strategies. RESULTS: Both younger and older patients who were psychologically distressed used more maladaptive coping. Individuals who received less social support from healthcare providers used more maladaptive coping strategies. For younger patients, self-transcendence was the only significant predictor of both adaptive and maladaptive coping strategies; for older patients, Hospital Anxiety and Depression Scale score was the only significant predictor of maladaptive coping. CONCLUSION: Differences in psychological distress, social support, and self-transcendence due to age are important protective or risk factors for the use of coping strategies among CRC patients. IMPLICATIONS FOR PRACTICE: Considering our findings, we encourage healthcare professionals to be aware of patients' coping strategies and take them into account when planning age-specific interventions related to coping, before hospital discharge.

The moderating role of the amount of caregiving tasks on the relationships between dementia caregivers' characteristics and outcomes.

AIM: This study identified the moderating role of the amount of caregiving tasks on relationships between dementia family caregivers' characteristics (age, education, etc.) and outcomes (burden, etc.). DESIGN: A cross-sectional analysis of surveyed data. METHOD: A convenience sample of 369 family caregivers (151 males, 218 females) aged 20 years or older was recruited from 10 cities in the southern area of South Korea. Data were collected from November-December 2011. Measures of caregiver burden, perceived health status and emotional distress of caregivers related to the memory-behaviour problems of the care recipient were used to assess the outcomes of family caregivers of older adults with dementia. RESULTS: The amount of caregiving tasks has a moderating effect on the relationships between caregivers' characteristics (such as living with the recipient and duration of caregiving) and the caregiver burden. The interaction between the amount of caregiving tasks and status of living with recipient was significant in relation to the emotional distress of caregivers related to the memory-behaviour problems of the care recipient with dementia; however, there was no effect of the amount of caregiving tasks on the relationships between caregivers' characteristics and perceived health status. CONCLUSION: The amount of caregiving tasks can have a moderating role in the caregiving stress model. Intervention programs need to be developed and implemented to reduce negative outcomes of family caregivers, particularly those living with older adults with dementia.

Gender Differences in Sexual Behaviors in Korean Adolescents.

PURPOSE: The purposes of this study were to identify whether there are gender differences in sexual behaviors among Korean adolescents and to explore the factors that influence safe sex practices across both sexes. METHODS: A secondary analysis was conducted using nationally representative data obtained from the 2014 Youth Risk Behavior Web-based Survey. Sample consisted of 3,210 adolescents who had experience of sexual intercourse. The dependent variable in this study was practicing safe sex. The independent variables included a range of individual, family, and school factors. RESULTS: Female adolescents were less likely to practice safe sex (i.e., always using a condom). Individual (smoking, no drinking before sexual intercourse), family (living with parents, higher allowance per week) and school factors (non-coeducational school students, had received school-based sex education) were significant predictors of practicing safe sex in males. In contrast, family (lower economic status) and school factors (middle school students) predicted practicing safe sex among female adolescents. CONCLUSION: We demonstrated that gender plays an important role in the sexual behavior of adolescents. The findings of this study indicate a need to design and implement gender-specific interventions.

Gender Differences in Factors Associated With Colorectal Cancer Screening: A National Cross-Sectional Study in Korea.

The rate of and factors influencing colorectal cancer screening differs by gender. We aimed to determine the behaviors for and predict the factors influencing self-reported colorectal cancer screening in Korean adults. Secondary analysis was performed with data from the cross-sectional 2012 Community Health Survey. We examined the relationship between gender and self-reported screening using data for 115 045 adults aged ≥50 years; 62.4% of men and 65.5% of women underwent colorectal cancer screening. In the multivariate logistic regression analysis, men with private insurance and who attended regular health checkups were more likely to undergo screening; men who were employed, ate salty food, were older, or smoked were less likely. Women with private insurance, who lived with a spouse, were more educated, were housewives, or attended regular health checkups were more likely, and older women were less likely to undergo screening. Therefore, gender-specific interventions are needed to encourage colorectal cancer screening.

Associations among daytime sleepiness, depression and suicidal ideation in Korean adolescents.

The aim of this study was to examine the effects of daytime sleepiness on depression and suicidal ideation in adolescent high-school students. A survey of 538 high school students aged 16-17 years attending two academic schools was conducted. The Epworth Sleepiness Scale (ESS), the Beck Depression Inventory and the Scale for Suicide Ideation were used to assess subjects' daytime sleepiness, depression and suicidal ideation. The mean score for daytime sleepiness was 8.52, which indicates a sleep deficit. Significant positive correlations were found between daytime sleepiness and depression, between daytime sleepiness and suicidal ideation and between depression and suicidal ideation. Gender and depression were significant predictors of suicidal ideation, accounting for 48% of the variance in this measure. Depression acts as a mediator of the relationship between daytime sleepiness and suicidal ideation. High school students in Korea generally have insufficient sleep time and feel sleepy during the day; insufficient sleep during adolescence may be associated with depression and suicidal ideation.

Breast cancer screening among shift workers: a nationwide population-based survey in Korea.

We aimed to examine the association between shift work types and participation in breast cancer screening (BCS) programs by comparing rates of participation for BCS among regular daytime workers and alternative shift workers using data from a nationally representative, population-based survey conducted in Korea. In addition, the results were analyzed according to sociodemographic factors, including occupation, education, income, private health insurance, age, and number of working hours a week. This secondary cross-sectional analysis used data from the 2012 Korean National Health and Nutritional Examination Survey. The target population included women aged ≥ 40 years who responded as to whether they had undergone BCS in the previous year. Accordingly, we analyzed survey data for a total of 1,193 women and used a multivariate logistic regression analysis to evaluate the differences in factors affecting BCS between regular daytime and alternative shift workers. A logistic regression analysis was performed considering private health insurance as a significant sociodemographic factor for BCS among regular daytime shift workers. In contrast, none of the tested variables could significantly predict adherence to BCS among alternative shift workers. The results of this study suggest the need for the development of comprehensive workplace breast cancer prevention programs by considering shift work types. More attention should be given to female workers with low education levels, those who are uninsured, and young workers to improve the participation rate for BCS at the workplace.

Perceptions of Continuing Nursing Education in Korea.

BACKGROUND: Few empirical studies examine nurses' perceptions of continuing nursing education and its outcomes regarding the quality of delivered service. This study investigated nurses' perceptions and persisting challenges with continuing nursing education. METHOD: Data were collected from 17 nurses with at least 2 years of work experience who had completed at least one continuing nursing education program at three university hospitals in South Korea. Demographic questionnaire data were collected and a prepared interview was used to lead focus group interaction. Phenomenological content analysis was performed immediately following each interview. RESULTS: Three main themes of continuing nursing education perceptions emerged: Feelings Toward Completing Continuing Nursing Education (Burden And Ambivalence); Perceptions of Completing Continuing Nursing Education Programs (Perceived Benefits and Problems); and Continuing Nursing Education-Related Educational Needs (Relevance to Practice and Reflection of Participants' Needs). CONCLUSION: A regionally and institutionally expanded study was proposed to qualitatively assess nurses' experiences on completion of continuing nursing education. J Contin Educ Nurs. 2016;47(12):566-572.

Pamidronate Down-regulates Tumor Necrosis Factor-alpha Induced Matrix Metalloproteinases Expression in Human Intervertebral Disc Cells.

BACKGROUND: N-containing bisphosphonates (BPs), such as pamidronate and risedronate, can inhibit osteoclastic function and reduce osteoclast number by inducing apoptotic cell death in osteoclasts. The aim of this study is to demonstrate the effect of pamidronate, second generation nitrogen-containing BPs and to elucidate matrix metallo-proteinases (MMPs) mRNA expression under serum starvation and/or tumor necrosis factor alpha (TNF-α) stimulation on metabolism of intervertebral disc (IVD) cells in vitro. METHODS: Firstly, to test the effect of pamidronate on IVD cells in vitro, various concentrations (10(-12), 10(-10), 10(-8), and 10(-6) M) of pamidronate were administered to IVD cells. Then DNA and proteoglycan synthesis were measured and messenger RNA (mRNA) expressions of type I collagen, type II collagen, and aggrecan were analyzed. Secondly, to elucidate the expression of MMPs mRNA in human IVD cells under the lower serum status, IVD cells were cultivated in full serum or 1% serum. Thirdly, to elucidate the expression of MMPs mRNA in IVD cells under the stimulation of 1% serum and TNF-α (10 ng/mL) In this study, IVD cells were cultivated in three dimensional alginate bead. RESULTS: Under the lower serum culture, IVD cells in alginate beads showed upregulation of MMP 2, 3, 9, 13 mRNA. The cells in lower serum and TNF-α also demonstrated upregulation of MMP-2, 3, 9, and 13 mRNA. The cells with various doses of pamidronate and lower serum and TNF-α were reveled partial down-regulation of MMPs. CONCLUSIONS: Pamidronate, N-containing second generation BPs, was safe in metabolism of IVD in vitro maintaining chondrogenic phenotype and matrix synthesis, and down-regulated TNF-α induced MMPs expression.

Daphnane Diterpenes from Daphne genkwa Activate Nurr1 and Have a Neuroprotective Effect in an Animal Model of Parkinson's Disease.

Nurr1 is an orphan nuclear receptor that is essential for the differentiation and maintenance of dopaminergic neurons in the brain, and it is a therapeutic target for Parkinson's disease (PD). During the screening for Nurr1 activators from natural sources using cell-based assay systems, a methanol extract of the combined stems and roots of Daphne genkwa was found to activate the transcriptional function of Nurr1 at a concentration of 3 µg/mL. The active components were isolated and identified as genkwanine N (1) and yuanhuacin (2). Both compounds 1 and 2 significantly enhanced the function of Nurr1 at 0.3 µM. Nurr1-specific siRNA abolished the activity of 1 and 2, strongly suggesting that transcriptional activation by 1 and 2 occurred through the modulation of Nurr1 function. Additionally, treatment with 1 and 2 inhibited 6-hydroxydopamine (6-OHDA)-induced neuronal cell death and lipopolysaccharide (LPS)-induced neuroinflammation. Moreover, in a 6-OHDA-lesioned rat model of PD, intraperitoneal administration of 2 (0.5 mg/kg/day) for 2 weeks significantly improved behavioral deficits and reduced tyrosine hydroxylase (TH)-positive dopaminergic neuron death induced by 6-OHDA injection and had a beneficial effect on the inflammatory response in the brain. Accordingly, compounds 1 and 2, the first reported Nurr1 activators of natural origin, are potential lead compounds for the treatment of PD.

Impact of Psychoeducation on Knowledge of and Attitude Toward Medications in Clients With Schizophrenia and Schizoaffective Disorders.

PURPOSE: To examine a psychoeducational intervention's effects on knowledge and attitudes toward antipsychotic medication in clients with schizophrenia and schizoaffective disorders. DESIGNS AND METHODS: A one-group pretest-posttest design was employed. A convenience sample (61 psychiatric clients aged 20 or above) was recruited from a Korean mental health center. FINDINGS: At baseline, participants had limited knowledge (M = 50.89, range: 27-77, SD = 12.05) of and negative feelings toward antipsychotic medications (M = -.89, range: -8 to 8, SD = 4.27). Both measures significantly improved post-intervention. PRACTICE IMPLICATIONS: A psychoeducational intervention improved clients' knowledge of and attitudes toward antipsychotic medications.