Development of a model of rehabilitation exercise and sports service delivery system for health promotion of people with disabilities.

People with disabilities (PWD) suffer from chronic diseases and other problems due to their low physical activity compared to people without disabilities. Physical activity and exercise can prevent chronic diseases and improve health management. However, PWD do not receive proper rehabilitation exercise and sports services immediately after dicharge from hospitals. An effective model of rehabilitation exercise and sports service delivery system has not been established in Korea. This study aimed to present such a model for health promotion, which enables PWD to participate in exercise regularly in local communities. The model is presented by dividing it into sides of consumers and suppliers by analyzing domestic and foreign rehabilitation and sports service systems and expert meetings. The system presented in this study can help promote returning to normal social life and transition into sports in daily life for PWD. In addition, it is expected to positively affect local communities through training instructors in rehabilitation exercise and sports; it can serve as a bridge between rehabilitation in medical institutes and sports in daily life.

Investigating socioecological obesogenic factors in children with Autism Spectrum Disorder.

Obesity-related information in children with Autism Spectrum Disorder (ASD) is limited, and research findings are contradictory. Thus, this study aimed to use a nationwide non-clinical sample to examine the association of sociological factors with overweight status in children with ASD and reveal the degree of differences in the risk factors for overweight in children with and without ASD. The data for this cross-sectional study, based on the modified ecological system theory model, were obtained from the 2019 National Survey of Children's Health. The weighted logistic regressions were performed to determine the factors associated with overweight status in children with ASD, controlling for demographics, physical activity-related behaviors, and family and environmental conditions. A total of 529 children were identified (mean age 13.78 years, 83.21% boys). Two-parent households, less healthy parents and households, households with smokers, poor sleep quality, and greater participation in organized activities were associated with a higher likelihood of overweight in children with ASD (all P < 0.05). The determinants of obesity among children with ASD go beyond the individual level; family and community support are important. Therefore, greater attention should be directed toward the families of children with ASD and community-level administrative policies to improve quality of life by preventing or reducing obesity in children with ASD.

Exploring the Relationship between Physical Activities and Health-Related Factors in the Health-Related Quality of Life among People with Disability in Korea.

The purpose of this study is to explore the relationship between modes (e.g., frequency and total time) of physical activity and health-related conditions of disabled people on their health-related quality of life (HRQoL) in Korea. This study is a cross-sectional research funded by the Ministry of Health and Welfare. Data was obtained from the 2017 disability survey. A total of 6549 people with disabilities (Mage = 61.92, SD = 17.36; Male = 55.98%) were analyzed in this study. The higher the frequency of physical activity for the disabled in Korea, the more positive the HRQoL (p < 0.001). Among the elderly disabled, the higher the severity of disability and educational degree, the lower the HRQoL (all p < 0.05). Disabled people who had fewer diseases and lived an independent socio-economic and cultural life had a higher HRQoL (all p < 0.001). This study revealed different dimensions of how health-related factors influence the quality of life of people with disabilities. More attention should be paid to supporting people in being independent and active, in order to help them maintain a healthy life. Especially, the barriers to physical activity faced by disabled people are multi-layered and multifaceted. Increasing the frequency of physical activity for disabled people is not only beneficial for their physical function, but also for their HRQoL. This study enables welfare promotion for disabled people through various policies and incentives. Further, this will be an opportunity to reduce the socio-economic burden on medical and health-related services related to the disabled population.

Investigating the impact of adapted physical education service-learning projects on preservice teachers' attitudes toward individuals with disabilities.

Service-learning (SL) has been implemented widely in teacher education to connect knowledge and practical experiences. In the field of Physical Education Teacher Education, Adapted Physical Education (APE) Courses have been implemented SL to provide hands-on experiences to promote preservice teachers' attitudes toward individuals with disabilities. The purpose of this study is to investigate the effectiveness of two SL projects, the volunteer project, and the parasports project, in the Intro APE course on preservice teachers' attitudes toward individuals with disabilities. A total of 130 preservice teachers participated in this study taking the Multidimensional Attitude Scale Toward Persons with Disabilities (MAS) before and after completing two SL projects. The result of the t-test indicated that there is no difference in overall MAS scores between pre- and posttest (Meanpre=2.954, SDpre=0.689, Meanpost=3.01, SDpost=0.679; t(129)=0.390, P=0.784). However, the significant increase observed in affects subscale of MAS (Meanpre=3.47, SDpre=0.374, Meanpost=3.52, SDpost=0.188; t(129)= 0.347, P=0.327). Our finding indicated cognition and behavior of preservice teachers toward individuals with disabilities were positively increased, but not significantly improved yet. Evidence suggested that two SL projects in this study did not significantly improve the overall positive attitudes of preservice teachers toward individuals with disabilities, but it was meaningful to observe that preservice teachers increased their affects toward individuals with disabilities.

Health-related factors leading to disabilities in Korea: Survival analysis.

The purpose of this study is to analyze (a) population and socioeconomic factors affecting disability, excluding the occurrence of disability due to accidents and congenital diseases, and (b) health-related behavioral factors and factors that can prevent and reduce the cause of disability due to disease in Korea. This study was a longitudinal research. Data were obtained from The 2018 Korean Health Panel (KHP) is a survey jointly conducted by the Korea Institute of Health and Social Affairs and the National Health Insurance Service. A total of 7, 372 (Mage = 52.14, SD = 21.39; Male = 47.52%) were analyzed in this study. People with Higher education attainments and more income levels were associated with lower hazard of developing new disabilities (all p < 0.05). In this study, the health factors that could be related to the occurrence of new disabilities were smoking, alcohol consumption, physical activity, and stress (all p < 0.0001). However, physical activity was negatively associated with the risk of developing a disability at all follow-ups (p < 0.05). Higher scores on the number of chronic diseases (valid scores = 0, 1, 2, 3, or more) represented a greater level of newly developing disability present at all follow-ups (all p < 0.0001). This longitudinal study confirmed the relationship between health-related factors and specific chronic diseases. Its findings can be used as a crucial foundation for establishing healthcare policies and services that can lower and prevent disability by preventing and reducing specific negative health behaviors and unhealthy behavioral factors, and alleviating chronic diseases in Korea.

Effects of the Head Start Program on Socioecological Obesogenic Factors in American Children.

Head Start is a nationwide developmental program for low-income families. This study aimed to investigate the association between the Head Start program and children's BMI status, as well as their quality of life with respect to socioecological obesogenic factors. This cross-sectional study employed the Early Childhood Longitudinal Study-Kindergarten cohort (ECLS-K) in which the data were collected in 2007 and analyzed in 2019. Propensity-score matching analysis was performed to examine the association between the Head Start program and children's BMI status, as well as the quality of life, controlling for socioecological obesogenic factors. A total of 3753 children (representing 1,284,209 at the population level) were recruited in this study (mean age: 13.69 years; girls: 49.42%). In the final matched model, the program did not have a statistically significant effect on children's obesity. Fewer African American children participated in school-sponsored activities, perceived themselves as overweight, lived in a household with fewer family members, had less strict TV regulations, and were more likely to be overweight than their counterparts. Outcomes suggest that multiple dimensions of sociological obesogenic factors including individual, parental, familial, and community support factors affect the weight of children from low-income families and should be considered when establishing behavioral and policy interventions to thwart the childhood obesity epidemic.

Adapted Physical Education: The Perspective of Asian Parents.

The purpose of this study was to examine the expectations from Adapted Physical Education services from the perspective of Asian parents (n = 8) who have children with disabilities. Data collection involved semi-structured interviews, completed in the participants' preferred language. The data were analyzed using Braun and Clarke's recipe for thematic analysis. Four themes emerged: (a) "overcoming" the disability in APE, (b) different perspectives on the importance of APE between mothers and fathers, (c) parents' concern over children being "disrespectful," and (d) communication issues. Since the culture in the United States is ethnically and socially more diversified, the significance and relevance of the results for effective, culturally sensitive APE provision is discussed. An increased understanding and involvement of Asian parents in terms of their children's APE program will result in more culturally sensitive, effective, and relevant APE experiences.

Longitudinal analysis of Socioecological obesogenic factors in a National Sample of U.S. children.

BACKGROUND: Childhood obesity is a serious public health threat. Although many researchers conducted research on socioecological determinants of childhood obesity, their longitudinal effects remain inconclusive especially among young children. This study examined socioecological factors and associated transitions of children's body mass index (BMI) status throughout children's kindergarten to elementary school years, using data from a national longitudinal sample. METHODS: The baseline sample of this study included 1264 children (weighted N = 379,297) extracted from the Early Childhood Longitudinal Study (baseline mean age: 5.24 years). The socioecological framework guided selection of socioecological obesogenic variables (e.g., family activity and parental involvement). Longitudinal ordered logistic regressions were performed to determine the associations between socioecological obesogenic variables and unhealthy/healthy changes in BMI status that captured transitions between healthy and unhealthy weight status (i.e., overweight, obesity, and severe obesity). RESULTS: Children with Hispanic ethnicity and nonwhite, less socioeconomic and environmental support, and living in households with fewer family members were more likely than their counterparts to have unhealthy BMI status changes over time (all ps < 0.05). Over the study period, girls were less likely than boys to experience transitions to unhealthy BMI status (all ps < 0.05). CONCLUSION: As hypothesized a priori, the findings of the current affirmed multiple dimensions of how sociological obesogenic factors may influence children's BMI status changes in a longitudinal setting. In order to maintain children's long-term healthy weight, more attention should be paid to socioeconomic obesogenic factors surrounding children as well as individual determinants of obesity (e.g., being physically active and having well-balanced nutrition).

Multi-Year Examination of School-Based Programs in Preventing Childhood Obesity: A Case of a State Policy in the U.S.

This study examined the association between the obesogenic factors and the risk of suffering from weight excess in school-based state programs regarding physical activity, physical education, nutrition standards, and nutrition education in preventing childhood obesity. Data were drawn from the 1999-2011 Youth Risk Behavior Survey in the State of Mississippi (N = 8862; grades 9-12). Logistic regression with year-fixed effects was performed to capture the influence of the legislation on teenage obesity, controlling for demographics and nutrition- and physical activity-related behaviors. The age-, sex-, and ethnicity-adjusted mean of the body mass index had reduced since 2007 (year 1999: 23.52; year 2001: 23.53; year 2003: 23.76; year 2007: 24.26; year 2009: 24.29; and year 2011: 23.91). The legislation was significantly associated with a decreased likelihood of being overweight (year 2007, odds ratio (OR) = 0.686; year 2009, OR = 0.739; and year 2011, OR = 0.760; all p < 0.01). Children who were more sedentary, more frequently fasted to lose weight, and were less physically active and likelier to be overweight (OR = 1.05, 1.37, and 0.97, respectively; all p < 0.05), as were African-American children (OR = 0.64; p < 0.05) and female students (OR = 1.59; p < 0.05). In conclusion, schools are among the most easily modifiable settings for preventing childhood obesity and reducing its prevalence, with the implementation of physical activity and nutritional policies.

The Relationship between Flourishing and Depression in Children in the U.S. Using a Socioecological Perspective.

Children's flourishing is likely to be associated with achieving a positive mental and physical quality of life, which is considered as an important factor for helping children to overcome psychological adversity during the critical stage of emotional development. This study examined the relationships between children's flourishing and childhood depression. This was a cross-sectional study using the 2011-2012 National Children's Health Survey in the U.S. The conceptual framework that guided this study was a modified ecological system theory model. Multiple regressions were performed to investigate the associations between flourishing and pediatric depression, controlling for demographics, physical activity-related behaviors, family and environmental conditions. A total of 45,309 children (representing 33,293,823 children at the population level) were identified in this study (mean age: 13.63 years; female: 48.7%). Children's childhood depression was highly related to direct parenting functions, individual needs and environmental availabilities and accessibilities from a socioecological perspective. This study revealed multiple dimensions of how sociological factors influence children's flourishing and mental health. Parents' involvement in children's physical activities and family and social support are crucial for children's flourishing and mental health status. More attention needs to be paid to provide children with family and social support to help them to overcome and reduce childhood depression.

Socioecological Predictors on Psychological Flourishing in the US Adolescence.

This study examined the relationship between children's flourishing and socioecological factors, including individual and family characteristics. A total of 45,309 children were drawn from the 2011-2012 National Survey of Children's Health in the US (mean age = 13.6 years; male: 51.28%). An ordinary least square (OLS) regression was performed to examine the association between socioecological variables and flourishing. This study assessed children's individual needs (such as health, education, and emotional and behavioral development), their parents' parenting capacity (the ability to provide basic care and safety), and family factors (presence of community resources and family income). Children's individual characteristics, parent's capacities, and family functions were found to be significantly associated with children's flourishing. In conclusion, multilevel socioecological factors appeared to be associated with children's flourishing. Hence, parents' involvement in their children's physical activities, as well as family and social support, is crucial for children's flourishing. This study makes a significant contribution to the literature as research is lacking a correlation between socioecological factors and children's flourishing; in particular, very few studies have explored or investigated the manner by which children's socioecological health indicators and factors are associated with their flourishing.

Safety and Efficacy of Ultrasound-Guided High-Intensity Focused Ultrasound Treatment for Uterine Fibroids and Adenomyosis.

The objective of this study was to assess the tolerability and efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation using a Haifu JC Focused Ultrasound Tumor Therapeutic System (operating transducer frequency: 0.8 MHz, 300-400 W/cm2) under real-time ultrasound guidance (2.5- to 5.0-MHz imaging probe) for uterine fibroids and adenomyosis in 1807 patients (928 with fibroids and 889 with adenomyosis). Volume change and clinical symptom improvement after treatment were evaluated based on symptom severity scores and health-related quality of life scores using the Uterine Fibroid Symptom and Quality of Life questionnaires. At 3, 6 and 12 mo after treatment, symptom severity scores and health-related quality of life scores and reductions in volumes of uterine adenomyosis and fibroids all revealed good effects. The complication rate was 4.6% (84/1807). With supportive care, all complications resolved without any permanent adverse effects. Thus, USgHIFU is an effective, non-invasive modality for treating uterine fibroids and adenomyosis with manageable complications.

Abdominal wall endometriosis treatment by ultrasound-guided high-intensity focused ultrasound ablation: a case report.

Abdominal wall endometriosis (AWE) occurs in about 0.1% of people with endometriosis, and is often diagnosed postoperatively. Surgical resection is generally used to treat AWE. We successfully treated AWE with ultrasound-guided high-intensity focused ultrasound therapy (USgHIFU). A 37-year-old Korean female presented with a palpable subcutaneous nodule associated with cyclic pain and swelling during menstruation. She was recommended surgical excision three months ago. She had a history of laparoscopic surgery for endometriosis 4 years ago and was interested in less invasive methods of treatment. The 0.9 cm painful nodule was observed as a low-echoic shadow in transabdominal ultrasonography and as an iso-signal in T1 MRI images. USgHIFU treatment was performed under light sedation and completed when the hyperechoic area covered the entire lesion. HIFU treatment was effective without any postoperative complications such as blisters or skin burns. The lesion showed changes in hyper-intensity signal on T1 MRI images. Physical examination showed absence of pain or tenderness and three months later, the painful nodule shrunk, and the menstrual cyclic pain associated with the nodule disappeared. In conclusion, USgHIFU may represent an effective therapy for AWE.

High-rate algal pond coupled with a matrix of Spirogyra sp. for treatment of rural streams with nutrient pollution.

This study evaluated the unique features of a filamentous algae matrix (FAM) that can be applied to high rate algal ponds (HRAPs) as a promising way to remove nutrient from polluted rural streams. The results show that the HRAPs, coupled with the FAM, effectively removed nitrogen and phosphorus (79.8% and 81.2%, respectively), and achieved high production of DO, with a maximum of 11.0 g O2 g FAM-1 d-1. The FAM functioned wells as a screen to prevent excessive algae loss from the system and obtained relatively high biomass growth rate (0.032 mg L-1 d-1 for nitrogen and 0.344 mg L-1 d-1 for phosphorus). The harvested FAM was a useful fertilizer and the rate of addition of FAM were 1.52 kg d-1 ha-1 of nitrogen and 0.44 kg d-1 ha-1 of phosphorus. Thus, combining the HRAP with the FAM was an effective nutrient removal and resource utilization system for rural streams.

Toxicity study of reclaimed water on human embryonic kidney cells.

The importance of evaluating the toxic effects associated with the use of reclaimed water has been increasing. The purpose of this research was to investigate the cytotoxicity and molecular toxicity of reclaimed water on the human embryonic kidney 293 (HEK293) cells. The culture medium was synthesized using the reclaimed water samples. Wastewater treatment plant influent (WTI) and effluent (WTE), containing micropollutants at the nanogram per liter level, decreased cell proliferation (93.4-98.9% and 91.5-96.6% of the control, respectively) and increased cell damage (103.6-117.5% and 100.7-109% of the control, respectively) at all exposure times, except for a decrease in cell damage observed after an 8-h exposure to WTE. Membrane bioreactor permeate (MBRP) increased cell proliferation (102.1-106.7% of the control) and decreased cell damage at 8 and 12 h (92.4 and 98.4% of the control, respectively), but slightly increased cell damage at 24 h and later time points (101.1-104.9% of the control). All three water samples induced cell apoptosis (120.9-123.4% of the control). They also affected the expression of cell-cycle regulatory proteins (p16INK4a, p27Kip1, cyclin-dependent kinases 2 and 4, cyclin D1, and cyclin E) and apoptosis-related regulatory proteins (p-JNK, Bcl-2, caspase-9, and caspase-3). In conclusion, all three water samples showed cytotoxicity and molecular toxicity in the HEK293 cells, and the results of the cell-cycle and apoptosis regulatory protein expression after WTI and WTE treatments were consistent with the results of the cytotoxicity.

High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta.

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

Outcomes and prognostic factors of cervical cancer after concurrent chemoradiation.

AIM: Concurrent chemoradiation (CCRT) is the standard treatment for locally advanced cervical cancer. This study was undertaken to evaluate the outcomes and the prognostic factors for cervical cancer after CCRT. MATERIAL AND METHODS: The medical records of 174 patients with International Federation of Gynecology and Obstetrics stage IB1-IVA who were treated at three affiliated hospitals of the Catholic University of Korea between January 1999 and December 2008 were reviewed and analyzed. Patients received pelvic radiotherapy with one of three regimens of cisplatin-based chemotherapy concurrently and high-dose rate brachytherapy. The radiation field was extended to include para-aortic lymph nodes, if necessary. RESULTS: The median follow-up period was 29.5 months (range, 5-96 months). Using multivariate analysis, stage (P = 0.014), tumor size (P = 0.043), and clinical response (P = 0.001) had a significant effect on overall survival. Similarly, progression-free survival (PFS) was influenced by stage (P = 0.004), tumor size (P = 0.02), clinical response (P = 0.011), and normalized squamous cell carcinoma antigen level after CCRT (P = 0.007). The 5-year survival rates were 91.7% (standard error, 5.8%) for stages IB1-IIA, 71.5% (standard error, 7.8%) for stage IIB, 44.9% (standard error, 7.8%) for stage III, and 20.9% (standard error, 12.0%) for stage IVA. A total of 151 out of 174 patients (86.8%) completed the planned treatment. Toxicities were manageable with supportive therapy. CONCLUSIONS: Cisplatin-based CCRT is well-tolerated. Good clinical response revealed a favorable correlation to survival. A maximal effort to achieve this goal might prolong survival in patients with cervical cancer.

Disseminated peritoneal leiomyomatosis after hysterectomy: a case report.

BACKGROUND: Disseminated peritoneal leiomyomatosis (DPL) is a rare disease characterized by multiple benign leiomyomas arising in the pelvic and abdominal cavities in women. DPL is observed particularly in reproductive age groups and often mimics carcinomatosis grossly, but with benign histology and a favorable prognosis. The possible causes could be divided into hormonal, subperitoneal mesenchymal stem cells, metaplasia, genetic or iatrogenic after morcellation of myoma during laparoscopic surgery. Management includes surgery followed by adjuvant hormonal therapy, systemic chemotherapy or aromatase inhibitor treatment in cases of nonresectable disease. CASE: We report a case of DPL occurring after 2 previous operations including myomectomy and hysterectomy. After the DPL operation, the patient was treated with a gonadotropin-releasing hormone agonist for 6 months. One year after surgery, image analysis showed no evidence of disease. CONCLUSION: This rare condition must be considered even when a patient presents with abdominal masses after myomectomy followed by hysterectomy.

Single-port laparoscopic myomectomy using a new single-port transumbilical morcellation system: initial clinical study.

STUDY OBJECTIVE: To evaluate the feasibility of single-port laparoscopic myomectomy with transumbilical morcellation and suturing. DESIGN: Continuing prospective study (Canadian Task Force classification II-3). SETTING: University hospital. PATIENTS: Fifteen patients who underwent single-port laparoscopic myomectomy between September 2008 and October 2009 to remove single or multiple uterine myomas, at least 1 in each patient measuring greater than 4 cm in diameter. INTERVENTIONS: All single-port laparoscopic myomectomy procedures were performed by a single surgeon (Dr. Y.W. Kim). Myomas were extracted transumbilically by cutting the myomas into smaller pieces with a knife or a conventional electromechanical morcellator. After making a single 1.5- to 2.0-cm umbilical incision, the single-port system, created with a wound retractor and a surgical glove, was inserted. All operations were performed using conventional rigid straight laparoscopic instruments. Laparoscopic suturing was performed in intramural myomas and some subserosal myomas. MEASUREMENTS AND MAIN RESULTS: Patient mean (SD; range) age was 38.3 (5.6; 29-49) years. The number of myomas per patient was 1.6 (1.4; 1-6). The diameter of the largest myomas was 6.1 (1.5; 4.2-9.6) cm. In 4 patients, only a knife was required for transumbilical extraction of myomas, and in 11 patients, transumbilical morcellation with an electromechanical morcellator with or without a knife was used. Transumbilical drainage tubes were inserted into the pelvic cavity in 11 of 15 patients. Operative time was 96.7 (33.8; 35-150) minutes. The decrease in postoperative hemoglobin concentration was 1.8 (1.2; 0.4-3.6) g/dL. During the operations, no patients required blood transfusion. No patients developed postoperative fever. Neither bowel injury nor urinary tract injury occurred in any patient. The postoperative hospital stay was 3.1 (0.8; 2-4) days. CONCLUSION: Single-port transumbilical morcellation using a conventional electromechanical morcellator with or without a knife is feasible. Single-port laparoscopic myomectomy is an alternative method with cosmetic advantage.