Risk factors for depressive symptoms by age group among human immunodeficiency virus-infected adults in Korea.

We identified factors associated with depressive symptoms according to age group. We used data from a city-wide, cross-sectional survey conducted by the Seoul Metropolitan Government in 2014. Multivariable logistic regression analyses were performed to explore factors related to depressive symptoms. Depressive symptoms were assessed using a single item from the Korea National Health and Nutrition Examination Survey. Of the 370 subjects, 37.3% had depressive symptoms during the past 12 months. Compared to an age of ≥50 years, being 20-39 (adjusted odds ratio, 2.45; 95% confidence interval, 1.26-4.75) or 40-49 years (2.58; 1.32-5.06) of age was positively associated with depressive symptoms. In addition, a history of acquired immune deficiency syndrome-defining opportunistic disease (3.29; 1.09-9.92) and perceived discrimination (1.93; 1.16-3.20) in subjects aged 20-39 years, and poor subjective health (4.97; 1.42-17.32) in subjects aged 40-49 years, were associated with depressive symptoms, but no factor exhibited a significant association in subjects aged ≥ 50 years. In conclusion, a screening program that considers the factors identified in this study to prioritize patients with depression should be implemented.

Work hours and overtime of nurses working in Cambodian hospitals.

AIM: To examine the nature and prevalence of Cambodian nurses' work hours and overtime and related factors BACKGROUND: The chronic shortage of nursing workforce is a major cause of overtime among nurses. INTRODUCTION: Nursing shortage and working overtime among nurses negatively affect nurse and patient outcomes, but nurses' work hours and overtime in Cambodia have not been comprehensively examined. METHODS: A multicenter cross-sectional study was conducted in four Cambodian hospitals. Data were collected from 253 nurses providing direct nursing care using a questionnaire. The STROBE checklist was used for reporting this study. RESULTS: More than a fifth of staff nurses worked more than 48 h, which is the legal work hour limit in Cambodia. Two major reasons for working mandatory or voluntary overtime, on-call or 24-h on-call were (a) not wanting to let down colleagues and (b) able to get all work done. The number of patients cared for was related to whether or not nurses worked 48 h or more. CONCLUSION: Overtime work and adverse nurse scheduling are common in Cambodia. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse managers and healthcare institutes in Cambodia need to monitor Cambodian nurses' work hours, which are often beyond the legal work hour limit. Moreover, it is important to understand why nurses work overtime and develop health policies, strategies, and programs that can help promote patient and nurse safety and retain qualified nursing staff. The 24-h on-call practice needs to be regulated according to the labor policy in healthcare institutes to prevent adverse nurse and patient outcomes.

Retrospective cohort study on Korean adolescents' sleep, depression, school adjustment, and life satisfaction.

Sleep patterns have an important role in the physical and psychological health of adolescents. In this study, we investigated the effects of sleep duration on depression, school adjustment, and life satisfaction of adolescents. A retrospective cohort study was conducted using secondary data on first and second grade students in middle schools from the Korean Children and Youth Panel Survey. Those who responded to all items about sleep were selected, and those who were within 30 min of sleep duration difference across 1 year were selected. Participants who had no change in variables of personal factors, parental factors, and family environment across 1 year were selected (n = 421). Longer total sleep duration and shorter weekend oversleeping had effects on lower depression, higher school adjustment, and greater life satisfaction after adjusting for personal factors, parental factors, and family environment. Therefore, we propose that school nurses assess adolescents' sleep patterns and counsel and educate adolescents and their parents about the influence of sleep patterns on adolescents.

Preferences of older inpatients and their family caregivers for life-sustaining treatments in South Korea.

This descriptive cross-sectional survey aimed to investigate the preferences of older inpatients and their family caregivers for life-sustaining treatments (LSTs) and their influential factors. Inpatients aged 60 and older and their family caregivers in three acute hospitals in Seoul, South Korea, were invited to participate in the study. A total of 180 surveys were returned from 90 pairs of patients and family caregivers with a response rate of 95%. Older inpatients expressed a significantly high desire for "not wanting to have cardiopulmonary resuscitation" (χ2 = 10.07, p = 0.007) and "mechanical ventilator" (χ2 = 10.35, p = 0.006) compared to their caregivers. Given that experiences of conversations about LSTs was a common factor in both groups and may prevent futile LSTs, it is important for nurses to initiate and support patients and family caregivers, helping them engage in formal and informal conversations about future healthcare preferences.

Development and psychometric testing of the Health Literacy Index for Female Marriage Immigrants (HLI-FMI) in Korea.

This study aimed to develop and examine the psychometric properties of the Health Literacy Index for Female Marriage Immigrants (HLI-FMI). Study participants were 282 women who migrated to Korea from Asian countries to marry and had a mean age of 33.24 years and had immigrated a mean of 5.58 years ago. Data were collected between March 2013 and May 2013. An initial 31 preliminary items were developed based on literature reviews and focus group interviews, including three constructs of health literacy: skills (print, numeracy), tasks (access, understand, appraise, apply), and health contexts (health promotion and disease prevention, health care maintenance and treatment, health system navigation). Exploratory factor analyses of the HLI-FMI yielded 12 items in two factors: Access-Understand Health Literacy (seven items) and Appraise-Apply Health Literacy (five items; Cronbach's alpha = 0.74). Criterion validity was supported through a significant correlation with the Rapid Estimate of Adult Literacy in Medicine-Short Form. Guided by a classical test theory and item response theory, item difficulty and discrimination were within acceptable ranges. HLI-FMI scores were positively associated with participant education and Korean proficiency. The HLI-FMI appears to be the first valid and reliable comprehensive health literacy measure for evaluating health literacy in Korean female marriage immigrants.

Assessment of healthy behaviors for metabolic syndrome among Korean adults: a modified information-motivation-behavioral skills with psychological distress.

BACKGROUND: Since the worldwide incidence of metabolic syndrome (Mets) has rapidly increased, healthy behaviors such as weight control, engaging in physical activity, and healthy diet have been crucial in the management of Mets. The purpose of this study was to examine healthy behaviors practice and factors that affect the practice in relation to Mets on the basis of a modified Information-Motivation-Behavioral skills model (IMB) with psychological distress, which is a well-known factor affecting healthy behaviors among individuals with Mets. METHODS: Study participants were 267 community dwelling adults (M age: 54.0 ± 8.1 years) with Mets who were attending public health centers located in Seoul, South Korea. A structured questionnaire was administered in the areas of information, motivation, behavioral skills, and practice of Mets healthy behaviors and levels of psychological distress from May 2014 to September 2014. Structural equation modeling was used to test the modified IMB model. RESULTS: The modified IMB model had a good fit with the data, indicating that motivation and behavioral skills directly influenced the practice of Mets healthy behaviors, whereas information and psychological distress directly influenced motivation and influenced the practice of healthy behaviors through behavioral skills. These components of the modified IMB model explained 29.8 % of the variance in healthy behaviors for Mets. CONCLUSION: Findings suggested that strengthening motivation and behavioral skills for healthy behaviors can directly enhance healthy behavior practice. Providing information about Mets related healthy behaviors and strategies for psychological distress management can be used as the first line evidence based intervention to systemically enhance motivation and behavioral skills among individuals with Mets.

The revised Stress Measurement of Female Marriage Immigrants in Korea: Evaluation of the psychometric properties.

The twenty-one item Stress Measurement of Female Marriage Immigrants (SMFMI) was developed to assess stress of female marriage immigrants in Korea. This study reports the psychometric properties of a revised SMFMI (SMFMI-R) for application with female marriage immigrants to Korea who were raising children. Participants were 190 female marriage immigrants from China, Vietnam, the Philippines, and other Asian countries, who were recruited using convenience sampling between November 2013 and December 2013. Survey questionnaires were translated into study participants' native languages (Chinese, Vietnamese, and English). Principal component analysis yielded nineteen items in four factors (family, parenting, cultural, and economic stress), explaining 63.5% of the variance, which was slightly better than the original scale. Confirmatory factor analysis indicated adequate fit for the four-factor model. Based on classic test theory and item response theory, strong support was provided for item discrimination, item difficulty, and internal consistency (Cronbach's alpha = 0.923). SMFMI-R scores were negatively associated with Korean proficiency and subjective economic status. The SMFMI-R is a valid, reliable, and comprehensive measure of stress for female marriage immigrants and can provide useful information to develop intervention programs for those who may be at risk for emotional stress.

Metabolic syndrome and its related factors among Asian immigrant women in Korea.

In this study, we examined the prevalence and risk factors of metabolic syndrome among Asian immigrant women in Korea based on sociodemographics and health behavior-related characteristics. The sample included 271 women from the Philippines, China, Vietnam, and other Asian countries through marriage. Data were collected using a structured questionnaire and health examination. Among 67 immigrants who had complete data for determination of metabolic syndrome, 1.5% reported having metabolic syndrome, and 44.4% of the entire sample had reduced high-density lipoprotein cholesterol, which is four times higher than their Korean-born counterparts. After controlling for age, there were significant differences in body mass index, depending on the country of origin, and weight change since immigration. Immigrants who had gained weight since immigration also had higher systolic blood pressure and triglycerides. As well as weight change, immigrants who always consumed high-fat diets were at risk of higher triglycerides. Immigrants living in urban areas had lower high-density lipoprotein cholesterol. In order to reduce the risk of metabolic syndrome, interventions should be directed toward the prevention of weight gain and lower fat intake after immigrating to Korea.

Candidates' and policymakers' perspectives on the needs for a master's program in nursing.

BACKGROUND: Quality and safe care requires nurses with advanced knowledge and skills. Cambodia does not have a graduate-level nursing program; therefore, nurses are required to pursue advanced degrees in other countries. However, a master's degree nursing program is being established in this country. OBJECTIVES: To explore the needs of stakeholders in the master's nursing program in Cambodia to establish the curriculum. DESIGN: Students and graduates of Bachelor of Sciences in Nursing were surveyed, and policymakers were interviewed face-to-face. PARTICIPANTS: As candidates for the master's nursing program, 94 undergraduates and 37 graduates participated in the survey, and four policymakers working at the Ministry of Health and Cambodian Council of Nurses were interviewed. METHODS: Descriptive statistics and frequency analyses were utilized for quantitative data and qualitative data were thematically analyzed. RESULTS: All 131 undergraduates and graduates were willing to apply to the master's program in nursing mainly to improve their knowledge and skills. They cited financial burden as a challenge for their study. Their educational demands were closely related to Cambodia's social situation and reflected their aspiration for advanced degrees and to become nursing leaders. The policymakers unanimously agreed on the need for the program and suggested policies and strategies to operate the course and recognize the role of graduates with this qualification. They reinforced that the curriculum should be based on the law, regulation, and policy and reflect Cambodia's current situation by identifying the needs of students and hospital officials and investigating available resources. Their perspectives revealed their expectations for graduates to plan healthcare policies and support them as their coworkers. CONCLUSIONS: The establishment of nursing master's course should be accompanied by a policy to support nursing students. Nursing educators and experienced senior nurses should be included in this policymaking and they must participate in the development of the curriculum. It is suggested to develop an eclectic master's program in nursing that aggregates all opinions of stakeholders.

Predictive factors of depression among Asian female marriage immigrants in Korea.

This study investigated the prevailing rate of depression in female marriage immigrants in Korea and the predictive factors of their rates of depression. The study included 316 foreign female marriage immigrant participants. Four instruments yielded the data: the Center for Epidemiologic Studies Depression Scale and Multidimensional Scale of Perceived Social Support and questionnaires regarding the participants' Korean language ability and demographic data. The survey scales were translated into Korean, Vietnamese, Chinese, and English. The data collection was conducted by a face-to-face interview and translators were used when needed. The female marriage immigrants were found to have higher depression rates than women in the general Korean population. The predictive factors of depression for the female marriage immigrants included their country of origin, Korean speaking ability, and family support. Far more depression was found to occur in the Chinese participants, while the rate of depression was lower in those with competent Korean speaking ability and family support. An exploration of strategies to improve the speaking ability and family support of female marriage immigrants will be necessary in order to decrease their incidence of depression and the strategies should be differentiated based on the female marriage immigrants' country of origin.

Factors Associated with Smoking Behaviors in Out-of-School Youth: Based on an Ecological Model.

PURPOSE: To investigate the association between smoking behavior in out-of-school youths (OSY) and individual, interpersonal, and organizational factors through an ecological model. METHODS: Participants were 297 OSY aged 13-18 years, who visited J area's counseling center. The independent variables were self-control (intrapersonal factor), parental attachment and social network (interpersonal factors), and exposure to no-smoking policy (community factor). The dependent variable was smoking. Descriptive statistics, χ2-tests, correlation analyses, and logistic regression analysis were performed. RESULTS: The predictors of smoking in OSY were analyzed using demographic, intrapersonal, interpersonal, and community factors. Period after discontinuation of school, self-control, parental attachment, and friends' smoking behavior were significant predictors. Smoking behavior was found to decrease when the period after discontinuation of school was over than one year, when the parents attachment increased and when self-control increased. Conversely, smoking increased when friends' smoking increased. CONCLUSIONS: When administering smoking prevention programs for OSY, parental attachment and psychological traits, such as self-control, should be taken into consideration. Therefore, for effective results, such programs need to strengthen self-control, stress the importance of parental attachment through parent education, and enroll adolescents along with their friends who smoke. Implications and Contribution: Based on an ecological model, this descriptive survey, conducted to investigate the association between smoking behavior among out-of-school youths and individual, interpersonal, and organizational factors, proposes that smoking prevention programs should consider parental attachment and psychological traits, including self-control, for optimal effectiveness.

Nursing students' experiences of a global outreach program: A mixed-method study.

Global health competency is an essential capacity for nursing students. This study evaluated the effect of a global outreach program on global health competency and cultural self-efficacy in nursing students and examined the students' experiences with the program. Participants included thirty-one undergraduate nursing students at a university in Seoul, Republic of Korea, who participated in a global outreach program in 2015 and 2016. Quantitative data were collected before and after program participation using questionnaires evaluating global health competency and cultural self-efficacy, and were analyzed using descriptive statistics and paired t-tests. Both global health competency and cultural self-efficacy increased significantly after the global outreach program. Qualitative data were collected via focus group interviews and reflective journals, and were analyzed using conventional content analysis and thematic analysis, respectively. The results of the content and thematic analyses were compared, and two themes and eight-sub-themes were finally extracted through the data analysis. The program was effective in improving nursing students' global health competency and cultural self-efficacy.

The challenges and achievements of graduates of the nurse bridging program in Cambodia: A qualitative study.

BACKGROUND: As the shortage of qualified nurses is one of the primary healthcare issues in Cambodia, a two-year Nurse Bridging Program which grants bachelor's degrees to nurses with associate degrees was introduced. OBJECTIVES: This study explores the challenges and achievements that the graduates experienced during and after the Nurse Bridging Program. DESIGN: A qualitative approach was used in this study. SETTING: The Nurse Bridging Program was conducted in a university in Cambodia from 2015 to 2016. This study was conducted 1 year after the Nurse Bridging Program. PARTICIPANTS: A group of 38 graduates participated in the online survey and 3 graduates participated in a focus group interview. METHODS: Sequential data collection for explanatory follow-up design was used in this study. The data obtained were analyzed using content and thematic analyses. RESULTS: Participants reported challenges such as unfamiliarity with research, difficulty with a foreign language, and shortage of time. They tried to overcome these challenges, and this experience improved their nursing and research competencies, which improved their job prospects and aspirations of further studies. CONCLUSIONS: The Nurse Bridging Program helped the nurses improve the quality of their work and develop their potential as nursing leaders.

Prediction model of blood pressure control in community-dwelling hypertensive adults in Korea.

The purpose of the present descriptive study was to test a hypothetical model explaining the factors that influence blood pressure control among hypertensive Korean adults > or = 20 years of age. Subjects were 1041 individuals with hypertension identified from 2005 Korean National Health and Nutrition Examination Survey data. Twelve of the 24 hypothesized paths in the structural model were significant. Gender (beta = 0.09, P < 0.00), medication (beta = -0.24, P < 0.00), regular physical activity (beta = 0.06, P = 0.02) and comorbidity (beta = 0.14, P < 0.00) were significantly associated with blood pressure control, representing 10% of the variance therein. The fit of the model to the data was supported. The study results indicate that health professionals should develop strategies to motivate compliance with antihypertensive medication and regular physical activity of hypertensive adults.

The evaluation of a multimodal hand hygiene improvement strategy in Cambodian hospitals.

INTRODUCTION: Hand hygiene is the most effective method of preventing healthcare-associated infections. Healthcare-associated infections are considered serious in developing countries, and there are few reports on the hand-hygiene status of these countries. Thus, we evaluated hand-hygiene status in eight hospitals in Cambodia to understand and identify factors hindering effective infection control. METHODOLOGY: Eight infection-management instructors working in one of the eight Cambodian government hospitals in a large city were interviewed with the WHO Hand Hygiene Self-Assessment Framework. RESULTS: The mean Hand Hygiene Self-Assessment Framework score across the eight hospitals was 177.81 ± 56.73. The overall level of compliance with the multimodal hand hygiene improvement strategy across these eight hospitals was basic-two hospitals scored inadequate and six hospitals scored basic. The scores for the 5 factors of the Hand Hygiene Self-Assessment Framework were as follows: 45.63 ± 15.45 for system change, 33.13 ± 16.89 for education and training, 27.81 ± 21.65 for evaluation and feedback, 58.13 ± 5.30 for reminders in the workplace, and 13.13 ± 11.00 for institutional safety climate for hand hygiene CONCLUSIONS: The promotion of hand hygiene compliance requires the establishment of a basic infrastructure, reinforcement of the hand hygiene education system, and provision of diverse educational materials, as well as the fostering of a professional workforce for education. Hospitals should also bolster their management systems for hand hygiene compliance.

The Longitudinal Mediating Effects of Perceived Parental Neglect on Changes in Korean Adolescents' Life Satisfaction by Gender.

PURPOSE: The life satisfaction of Korean adolescents tends to decrease beginning in middle school, and this decrease has a negative effect on life satisfaction in adulthood. Gender and perceptions of parental neglect are important variables influencing the life satisfaction of adolescents in Korea. This study examined the longitudinal mediating effects of perceived parental neglect on the life satisfaction of male and female Korean adolescents to assess changes to the relationships between key variables over time. METHODS: The present study analyzed data from 2,215 adolescents from the Korean Children and Youth Panel Survey's fourth-year elementary school panel spanning their first year of middle school (2013) to the first year of high school (2016). A latent growth model was applied to Korean national data. RESULTS: The perceived parental neglect and life satisfaction intercepts differed by gender, and the intercept of perceived parental neglect influenced the life satisfaction intercept. The slope of perceived parental neglect, but not the life satisfaction slope, differed by gender, and the slope of perceived parental neglect influenced the life satisfaction slope. The Sobel method showed that the intercept of perceived parental neglect mediated gender differences in the life satisfaction intercept, and the slope of perceived parental neglect significantly influenced the gender difference in the life satisfaction slope. CONCLUSION: Efforts to improve adolescent life satisfaction should be differentiated by gender regarding perceptions of parental neglect.

Nursing student and faculty competency improvement through a nurse-bridging program in Cambodia.

BACKGROUND: An adequate number of high-quality nurses are a key factor for superior patient outcomes. However, in 2015, Cambodia reported only 52 nurses with bachelor's degrees, three with master's degrees, and one with a doctorate. The fast track to getting a highly educated nursing workforce requires providing a bridging program for associate's degree nurses to achieve baccalaureate degrees. OBJECTIVES: To assess improvement in the competency of nursing students and faculty members through a program that prepares associate's degree nurses to obtain bachelor's degrees in Cambodia. DESIGN: Mixed methods. SETTING: Educational institutes in Phnom Penh, Cambodia. PARTICIPANTS: A total of 45 Cambodian nursing students participated in the Cambodian nurse-bridging program and 12 Cambodian faculty members served as co-teachers. METHODS: We conducted three surveys to compare the competence of nursing students and faculty members before, during, and after the bridging program. We conducted focus-group interviews to support the qualitative results and explored changes in student and faculty competencies after the program. RESULTS: Quantitative analysis revealed significant improvements in students' nursing competency (p < .001), critical thinking (p < .001), and research competency (p < .001) and faculty members' teaching competency (p < .001) and research competency (p < .001) after the program. Through qualitative analysis, students showed improvement in physical assessment, patient communication, critical thinking, evidence-based nursing, and research competency. Faculty members indicated they had experienced new teaching strategies and subjects, gained increased confidence in teaching, and even though research competency had been improved, more training was required. CONCLUSIONS: This study provides evidence to support the effectiveness of higher nurse education in developing countries, and illustrates an opportunity to produce high-quality human resources in nursing.

Analysis of Validity and Reliability of the Health Literacy Index for Female Marriage Immigrants (HLI-FMI).

The purpose of this study was to obtain an independent evaluation of the factor structure of the 12-item Health Literacy Index for Female Marriage Immigrants (HLI-FMI), the first measure for assessing health literacy for FMIs in Korea. Participants were 250 Asian women who migrated from China, Vietnam, and the Philippines to marry. The HLI-FMI was originally developed and administered in Korean, and other questionnaires were translated into participants' native languages. The HLI-FMI consisted of 2 factors: (1) Access-Understand Health Literacy (7 items) and (2) Appraise-Apply Health Literacy (5 items); Cronbach's α = .73. Confirmatory factor analysis indicated adequate fit for the 2-factor model. HLI-FMI scores were positively associated with time since immigration and Korean proficiency. Based on classical test theory and item response theory, strong support was provided for item discrimination and item difficulty. Findings suggested that the HLI-FMI is an easily administered, reliable, and valid scale.

[Effects of Dietary and Physical Activity Interventions on Metabolic Syndrome: A Meta-analysis].

PURPOSE: This study identified effects of dietary and physical activity interventions including dietary interventions or physical activity interventions alone or combined dietary-physical activity interventions to improve symptoms in metabolic syndrome including abdominal obesity, high triglycerides, low high density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose through meta-analysis. METHODS: Articles on metabolic syndrome X published from 1988 to 2013 were searched through electronic databases, Google Scholar, and reference reviews. Methodological quality was assessed by the checklist, SIGN (Scottish Intercollegiate Guidelines Network). RESULTS: In the meta-analysis, there were 9 articles reporting 13 interventions with 736 participants. Using random effect models, the dietary and/or physical activity interventions showed a lower mean difference in waist circumference (-1.30 cm, 95% CI:-2.44~-0.15, p=.027). The combined dietary-physical activity interventions showed a lower mean difference in waist circumference (-2.77 cm, 95% CI:-4.77~-0.76, p=.007) and systolic blood pressure (-5.44 mmHg, 95% CI:-10.76~-0.12, p=.044). Additionally, interventions of over 24 weeks yielded a lower mean difference in waist circumference (-2.78 cm, 95% CI:-4.69~-0.87, p=.004) and diastolic blood pressure (-1.93 mmHg, 95% CI:-3.63~-0.22, p=.026). CONCLUSION: The findings indicate that dietary and/or physical activity interventions for metabolic syndrome reduce central obesity with no adverse effects. This finding provides objective evidences for dietary and physical activity management on metabolic syndrome as an efficient intervention.

Effects of Health Status and Health Behaviors on Depression Among Married Female Immigrants in South Korea.

PURPOSE: This study examined the effects of health status and health behaviors on depression in married female immigrants in South Korea. METHODS: Sampling 316 immigrant women from the Philippines, Vietnam, China, and other Asian countries, a cross-sectional research design was used with self-report questionnaires that assessed sociodemographic characteristics, health status, health behaviors, and depression. RESULTS: There were significant differences in stillbirth experience, induced abortion, morbidity, perceived health status, meal skipping, and physical activity between depressed and nondepressed immigrant women. After adjusting for sociodemographic variables, stillbirth experience, poorer perceived health status, more meal skipping, and less physical activity were associated with greater depressive symptoms. CONCLUSIONS: Both health status and health behaviors had significant impacts on depression, suggesting that development of nursing interventions and educational programs should be targeted towards improving maternal health, healthy lifestyle, and subjective health perception to promote married female immigrants' psychological well-being.