Effect of a Hospital-To-Home Transitional Intervention Based on an Interaction Model of Client Health Behavior for Adult Patients with Stroke.

To develop and identify the effectiveness of a hospital-to-home transitional intervention based on an interaction model of client health behavior in adult patients with stroke. A non-equivalent control group pretest-posttest. Thirty-eight patients participated (18=intervention, 20=control); the intervention group received 12 weeks of the intervention. The intervention influenced anxiety, disease severity, health behavior adherence, patient satisfaction, and quality of life in adult patients with stroke. Transitional programs have potential to improve the health behaviors of subjects, and community health nurses can assist in the implementation of these programs. Health behaviors and quality of life scores were significantly higher in the intervention group than in the control group; these findings support the need for continuity of nursing care during the transitional period for patients with stroke. Given the challenges faced by adult stroke patients after stroke, community nurses should pay attention to patients' transitional experiences.

A Pilot Study to Promote Active Living among Physically Inactive Korean American Women.

A 4-week lifestyle program called Women's Active Living for Koreans (WALK) was designed for Korean American women to promote physical activity (PA). In a pilot-controlled trial, 40 women were randomized to WALK-regular or WALK-plus. WALK-plus involved joining an online community via a social media app. WALK-plus performed significantly higher numbers of days of muscle-strengthening activities than WALK-regular at the post-intervention visit. Both groups increased vigorous activities and walking and decreased sedentary behaviors on weekdays. WALK program showed great potential in improving PA and decreasing sedentary behaviors. Online social networking may have an additional effect on PA among this population.

A predictive model of fear of cancer recurrence for patients undergoing chemotherapy.

PURPOSE: A number of cancer patients experience fear of cancer recurrence (FCR), which affects their psychological adjustment. This study tested the hypothesized model of FCR to predict psychological adjustment in cancer patients undergoing chemotherapy. METHODS: A total of 203 patients, who had been diagnosed with either breast cancer or colorectal cancer and were undergoing chemotherapy, were recruited from two university hospitals in Seoul, Korea. Data were collected using validated questionnaires and were analyzed using SPSS 24.0 and AMOS 25.0 program for structural equation modeling procedures. RESULTS: The fit index of the hypothesized model was appropriate. Symptom distress, contextual factors, FCR, and illness representations had statistically significant direct, indirect, and total effects on psychological adjustment. These variables explained 76% of the total variance of the psychological adjustment in cancer patients undergoing chemotherapy. Fear of cancer recurrence was a mediating factor for the effects of symptom distress, contextual factors, and illness representation on psychological adjustment. CONCLUSIONS: Based on these results, interventions aimed at reducing symptom distress and FCR, and improving social support, optimism, and illness representations, may be useful for the successful psychological adjustment of cancer patients undergoing chemotherapy.

Self-Management Program for Heart Healthy Behavior Among Middle- and Old-Aged Korean Women at Risk for Metabolic Syndrome.

BACKGROUND: The prevalence of metabolic syndrome (MetS) has been increasing among Koreans, and middle-aged and older women are at risk of metabolic syndrome. Effective strategies to promote lifestyle modification need to be developed. OBJECTIVE: We examined the effects of a self-management program on improving the cardiovascular health status and promoting healthy behaviors among overweight or obese Korean women at risk of metabolic syndrome. METHODS: A pretest and posttest intervention design was used. Sixty women participated in a group teaching session. They also received a pedometer and a diary for self-monitoring. On the basis of blood test results, women's metabolic syndrome status was identified. Thirty women with metabolic syndrome received additional tailored counseling and weekly follow-up calls for 4 weeks, whereas 30 women without metabolic syndrome did not receive any tailored counseling or follow-up calls. Twenty-three women in the MetS group and 22 women in the non-MetS group completed the posttest. RESULTS: Overall, women significantly improved their cardiovascular health status including systolic blood pressure, diastolic blood pressure, body mass index, low-density lipoprotein, triglycerides, number of metabolic syndrome risk factors, and 10-year risk estimates from pretest to posttest. Seventy-eight percent of the MetS group (n = 18) no longer had metabolic syndrome, whereas 5% of the non-MetS group (n = 1) became to have metabolic syndrome. Women significantly increased frequency and duration of walking per week and significantly decreased the time spent sitting. CONCLUSIONS: Promoting self-management for healthy behaviors might be effective for obese or overweight women to prevent metabolic syndrome and cardiovascular diseases, if it is tailored to their health needs.

Anger, anger expression, cardiovascular risk factors, and gastrointestinal symptoms by hwa-byung symptoms in Korean adult women.

PURPOSE: This study explored relationships of anger and anger expression to cardiovascular (CV) risk factors and gastrointestinal (GI) symptoms in Korean women based on hwa-byung (HB) symptoms. METHODS: A descriptive, comparative design was used. One-hundred four women who are from 20 to 65years old were recruited. Based on the HB score, 22 women indicated for HB and the rest were classified as normal. Data collection was done with several questionnaires including HB symptom scale, state-trait anger expression inventory, and GI symptom questionnaire and clinical information. RESULTS: Women with HB demonstrated significantly higher levels of trait anger and dysfunctional anger expression such as anger suppression and anger expression than normal group. Although blood pressure was higher in women with HB, the differences were not significant. Self-report of GI symptoms were significantly more in women with HB, however no significant difference was found in gastroscopy results. CONCLUSIONS: Women with HB were younger and might lack of sufficient social support. This study suggests relationship of anger and anger expression to functional GI symptoms. Characteristics of women with HB should be considered in developing intervention programs for healthy coping. Future studies need more women with HB for better comparison.

Fear of cancer recurrence in Korean women after breast cancer treatment: A mixed methods study.

PURPOSE: This study aimed to identify the fear of cancer recurrence (FCR) among Korean breast cancer survivors and further explore their experiences based on their level of FCR. METHODS: A mixed-methods study was conducted with a quantitative approach (phase I) followed by a qualitative approach (phase II) between August 2019 and February 2020.70 participants who completed the FCR inventory questionnaire were categorized into either high or low groups based on their FCR level. In phase II, in-depth interviews with 14 participants from phase I were conducted to explore their specific experiences of FCR. RESULTS: 38 participants (54.3%) experienced high levels of FCR, characterized by higher severity of FCR, more reaction to triggers, higher stress levels, more functional impairments, more insight, and frequent reassurance-seeking behaviors than those with low levels of FCR. Differences in FCR levels by age were statistically significant (F = 6.83, p = .002), and participants younger than 50 years had significantly higher FCR scores than those aged 60 years and older. Of similarities and differences found between the two groups, qualitative findings showed that the experience of the high FCR group was characterized by "living with cancer but keeping a certain distance from fear of recurrence" and that of the low FCR group was characterized by "living a healing life while controlling latent fears." CONCLUSIONS: It is necessary to help those survivors who experience high FCR reduce its negative impact on their health. These findings can serve as a basis to develop a personalized approach with better understanding of the FCR among Korean women.

Exploring Barriers to and Facilitators of Physical Activity among Korean American Women.

Physical inactivity is prevalent among ethnic minority women including Korean American (KA) women. We explored the barriers to and facilitators of physical activity (PA) and strategies to promote continued engagement in a PA program with a component of an online community. We conducted a qualitative descriptive study of 37 KA middle-aged women who used to be physically inactive and participated in an exit interview following postintervention visit. Using a thematic analysis approach to analyze the data, we found the individual, interpersonal, and neighborhood/community-level barriers to and facilitators of PA; social influence and social support-related themes were evident. Participants expressed benefit and interest in lifestyle modification using social media. Such program that reduces the barriers and reinforces the facilitators may be able to help motivate KA women to increase their PA.

Gender comparison in depressive symptoms and use of antidepressant medications after acute coronary syndrome.

Acute coronary syndrome (ACS) affects many aspects of female and male survivors' lives. This prospective longitudinal study explored gender differences in 100 patients hospitalized with ACS and 1 month follow-up. There were no significant differences in depressive symptoms (DS) by gender. However, significantly more females than males had a history of depression and reported being prescribed and taking antidepressants. Considering that 18 nonrespondents had higher DS at Time 1 than the did the others, DS at Time 2 could have been higher given that patients who are depressed tended not to respond at Time 2. Therefore, health care providers need to pay more attention to DS in ACS survivors, especially women whose early recovery experience might be different from men.

Comparison of the outcomes of robotic cholecystectomy and laparoscopic cholecystectomy.

PURPOSE: This study compared the effects of robotic single-port cholecystectomy (RC) and 3-port laparoscopic cholecystectomy (LC) on patients' surgical pain, postoperative complications, and satisfaction. METHODS: One hundred twenty patients with gallbladder disease scheduled for either LC or RC were recruited. Each patient was followed up for 1 week after hospital discharge. RESULTS: Time stayed in operating room was longer in patients with RC, however their hospital stay was shorter than those with LC (t = 3.01, P = 0.003). Since patients with RC received more analgesics during the surgery (t = 3.98, P < 0.001), all participants' surgical pain level were analyzed by using analysis of covariance. Patients who underwent RC reported less surgical pain consistently at 6 hours and first day after surgery and 2 days and 1 week later than patients in the LC. Repeated measure analysis of variance also demonstrated that the RC with single-port might cause less pain throughout the postoperative period (F = 25.68, P < 0.001). Participants' conditions appeared stable without complications such as infection or bleeding regardless of the surgical type however, overall satisfaction with RC showed significantly higher than those with LC except for one item, "the cost of surgery." CONCLUSION: These results suggested that the RC might be a better choice for people who concern about surgical pain and early hospital discharge. Since there were no differences in postoperative health status between the 2 groups, health care providers as an advocate can provide more reliable information to their patients.

CORRIGENDUM: Correction of the affiliation name. Comparison of the outcomes of robotic cholecystectomy and laparoscopic cholecystectomy.

[This corrects the article on p. 27 in vol. 93, PMID: 28706888.].

Application and Effect of Mobiletype-Bone Health Intervention in Korean Young Adult Women with Low Bone Mass: A Randomized Control Trial.

PURPOSE: This randomized control trial was designed to examine the effect on the self-managing ability for promoting bone health of mobile type-bone health intervention (mobile type-BHI). METHODS: The mobile type-BHI consisted of a mobile application called "Strong bone, Fit body" (SbFb) and group education. A total of 82 college women with low bone mass (Z score < -1) participated. They were assigned randomly to three groups, experimental group I, (n = 28), experimental group II (n = 32), and control group (n = 22). This study ran from June 2014 to January 2015. The outcome variables were bone mineral density, minerals related to bone metabolism (calcium, phosphorus, vitamin D), biochemical markers related to bone remodeling (osteocalcin, C-terminal telopeptide, sclerostin), food intake diary by 24 hours recall, and psychosocial variables related to bone health (knowledge, health belief and self-efficacy). Data were analyzed using SAS program and a computer aided nutritional analysis program. RESULTS: Both the experimental group I, who used mobile type-BHI, and experimental group II, who only received group education, showed outcomes regarding knowledge of the benefits of exercise and calcium as compared with the control group. The two experimental groups also demonstrated results in the serum levels of calcium, vitamin D, and sclerostin compared to those of the control group. CONCLUSION: Although both experimental groups exhibited positive outcomes in regards to the promotion of bone health, this study did not show an additional effect of the mobile application on self-management ability for the promotion of bone health. Nonetheless, the SbFb application is very meaningful as it is the first application developed with the aim of improving women's bone health.

[Bone mineral density, biochemical bone turnover markers and factors associated with bone health in young Korean women].

PURPOSE: This study was done to assess the bone mineral density (BMD), biochemical bone turnover markers (BTMs), and factors associated with bone health in young Korean women. METHODS: Participants were 1,298 women, ages 18-29, recruited in Korea. Measurements were BMD by calcaneus quantitative ultrasound, BTMs for Calcium, Phosphorus, Osteocalcin, and C-telopeptide cross-links (CTX), body composition by physical measurements, nutrients by food frequency questionnaire and psychosocial factors associated with bone health by self-report. RESULTS: The mean BMD (Z-score) was -0.94. 8.7% women had lower BMD (Z-score≤-2) and 14.3% women had higher BMD (Z-score≥0) than women of same age. BTMs were not significantly different between high-BMD (Z-score≥0) and low-BMD (Z-score<0) women. However, Osteocalcin and CTX were higher in women preferring caffeine intake, sedentary lifestyle and alcoholic drinks. Body composition and Calcium intake were significantly higher in high-BMD. Low-BMD women reported significantly higher susceptibility and barriers to exercise in health beliefs, lower bone health self-efficacy and promoting behaviors. CONCLUSION: Results of this study indicate that bone health of young Korean women is not good. Development of diverse strategies to intervene in factors such as exercise, nutrients, self-efficacy, health beliefs and behaviors, shown to be important, are needed to improve bone health.

Psychological distress in cardiac rehabilitation participants.

PURPOSE: Limited data are available on the psychosocial characteristics of patients entering cardiac rehabilitation (CR). We characterized the psychological and clinical profiles of men and women entering CR to determine which, if any, characteristic identifies persons at high risk for psychological distress. METHODS: The records of 417 patients enrolled in phase II CR between January 2001 and December 2004 were analyzed. One hundred forty-eight of these patients underwent a comprehensive Symptom Checklist-90 psychological survey. The analysis focused on measures of depression, anxiety, hostility, somatization, and a global severity index. RESULTS: Mean age of the patients was 60.6 years and 20.9% of them were women. More than one-third had a score of 90th percentile or more in at least 1 psychological category, and 23% had a score of 90th percentile or more in 3 or more categories. Approximately 20% and 36% of patients scoring in the 90th percentile or more and 98th percentile or more of depressive symptoms, respectively, had a history of depression. There was no difference in Symptom Checklist-90 scores by gender, age, education, work status, type of coronary event, metabolic syndrome, tobacco use, cerebrovascular disease, peripheral vascular disease, or diabetes. There was no relationship between psychological symptoms and indication for CR, although a trend of more somatic symptoms was seen in those who underwent an acute coronary syndrome and did not receive revascularization. CONCLUSION: Considering the prevalence of psychological distress in CR patients and the lack of clinical identifiers, routine assessment could help identify those who are at increased risk of noncompliance and may benefit from psychological and/or pharmacological intervention.

[Depression status of academic high school students in Seoul: mediating role of entrapment].

PURPOSE: Purpose of this study was to investigate the status of depression in academic high school students and path analysis model for exploring the mediating role of entrapment to depression in relation to academic stress and perceived social support. METHODS: Measurements were four reliable questionnaires measuring academic stress, social support, entrapment, and depression. Data were collected from students in 17 high schools in Seoul. RESULTS: Students (n=5,346) completing the questionnaires indicated depression & entrapment from academic stress. Depression was more prevalent in girls, those whose parents' household income was less than two million won, who did not live with father or mother or both due to divorce, separation, or death, and those who smoked or used alcohol. Entrapment was more prevalent in students similar to cases of depression and in seniors. According to the proposed path model, 48.6% of depression was explained by academic stress, social support, and entrapment. The indirect effect of entrapment as a mediator between academic stress and depression was verified and larger than the direct effect of academic stress on depression. CONCLUSION: Considering levels of depression and entrapment demonstrated by these students, better mental health programs with diverse strategies should be developed for their psychological well-being.

Relationship between survivors' perceived health status following acute coronary syndrome and depression symptoms during early recovery phase.

PURPOSE: To examine and describe perceived health status and depression symptoms among Acute Coronary Syndrome (ACS) survivors, and to examine their relationship during survivors' recovery phase. METHODS: A prospective design was used to test changeability of the key variables over a 1-month period for a cohort group of 82 post ACS patients, prior to their hospital discharge (Time 1) and at 4 weeks post discharge (Time 2). The revised version of Short Form-12 Health Survey and Beck Depression Inventory were used to measure the perceived health status and depression symptoms. The data were collected between 2003 and 2004. RESULTS: Perceived health status including mental health and physical health significantly improved over the 4-week period (t = -2.58, p <.05). Perceived health status during the hospitalization and length of hospital stay were significant predictors of depression symptoms during the early recovery phase. CONCLUSIONS: Patients' own perceptions about their health status need to be closely evaluated during the hospitalization in order to reduce the occurrences of later depression symptoms. Consequently, reducing depression symptoms and improving perceived health status should be addressed both in acute and chronic phases of ACS.

[Comparison of cardiovascular health status and health behaviors in Korean women based on household income].

PURPOSE: In this study cardiovascular health status and health behavior of Korean women based on their household income were explored. METHODS: For this cross-sectional study, 91 women residing in the community were recruited to complete survey questionnaires and biophysical tests including blood pressure (BP), body mass index (BMI), body fat rate, waist circumference (WC), and blood chemistry tests. RESULTS: Compared to non-low income women (NLIW), low income women (LIW) were more likely to be older, less educated, and jobless, and further more LIW were postmenopause and reported having been diagnosed with hypertension or hypercholesterolemia. Significant differences were found in systolic BP, triglyceride level, BMI, body fat rate, and WC between the groups. Two fifths of the LIW had indications for metabolic syndrome. Their 10-yr risk estimate of myocardial infarction or coronary death demonstrated a higher probability than that of NLIW. Although these significant differences were due to age gap between the groups, advanced age is known to be one of the key characteristics of LIW as well as a non-modifiable risk factor. CONCLUSION: Effective community programs for vulnerable women at risk of cardiovascular disease should be based on strategies targeting unhealthy behaviors and modifiable risk factors.