Development and Evaluation of a Hospice and Palliative Care Music Therapy Education Program.

Purpose: This study was conducted to develop a hospice music therapist training program and to evaluate its effects. Methods: The educational program consisted of training on the theory of hospice and the theory and practice of hospice music therapy. The course lasted for 4 weeks, with 8 hours of training per week, and 33 music therapists completed the course. In order to assess the effectiveness of the course, participants' knowledge and confidence regarding hospice music therapy and readiness for hospice music therapy before and after education were measured. The statistical analysis was done using SPSS version 18.0 and the paired t-test was used to assess the effectiveness of the program. Results: The trainees showed significant improvements in knowledge (P<0.001) and confidence (P<0.001) in all areas of this course, as well as in readiness for hospice music therapy (P<0.001). Participants' satisfaction with the lectures was assessed using a 5-point Likert scale. The average score for all lecture areas exceeded 4 (yes), and the satisfaction level was mostly high. Students were most satisfied with the lectures on music therapy theory, followed in order by those on music therapy practice and hospice theory. Conclusion: This hospice music therapist training program is considered to be suitable because of its positive educational effects and the high satisfaction of participants with the lectures. In order to provide high-quality music therapy services to patients and their families, this training course should be regularly offered to cultivate competent music therapists, and the content of the education should be standardized and applied in various clinical settings.

Suicidal ideation among postmenopausal women on hormone replacement therapy: The Korean National Health and Nutrition Examination Survey (KNHANES V) from 2010 to 2012.

BACKGROUND: Suicide is a major public health problem around the world. Some studies have found that hormone replacement therapy (HRT) is associated with depression in postmenopausal women. Depression is a well-known risk factor for suicide; therefore, we investigated the relationship between HRT and suicidal ideation in postmenopausal Korean women. METHODS: We included 2286 postmenopausal women with or without HRT from the Korean National Health and Nutrition Examination Survey 2010-2012. The use and duration of HRT and mental health status, including stress, depressive mood, and suicidal ideation and attempts, were assessed by self-report questionnaires. RESULTS: The proportion of participants with depressive mood and suicidal ideation was higher in the HRT group than the non-HRT group (all p values<0.05). As the duration of HRT increased, the percentage of participants with suicidal ideation increased (p for trend=0.006). After adjusting for all covariates, the odds ratio (95% confidence intervals) for suicidal ideation was 1.742 (1.223-2.482) in the women with HRT, compared to women without HRT. HRT duration longer than 10 years was associated with suicidal ideation (odds ratio=2.089 and 95% confidence intervals=1.069-4.084). LIMITATIONS: The cross-sectional design, a possibility of incorrect answer about menopausal status, and no assessment of the type of HRT are the main limitations of this study. CONCLUSION: Postmenopausal women receiving HRT, especially for more than 10 years, showed increased suicidal ideation compared with postmenopausal women without HRT. Physicians should pay attention to mood symptoms and suicidal ideation in postmenopausal women with HRT.

Complementary and alternative medicine use among cancer patients at the end of life: Korean national study.

OBJECTIVES: To investigate in depth the use of complementary and alternative medicines (CAMs) by cancer patients at the end-of-life (EOL) and how they communicate with physicians about them. DESIGN AND LOCATION: In 17 hospitals in Korea between January and December 2004 we identified 4,042 families of cancer patients. RESULTS: The prevalence of CAM use among cancer patients at the EOL was 37.0%, and 93.1% had used pharmacologic types of agents. The most frequent motive for CAM use was the recommendation of friends or a close relative (53.4%) or a physician (1.6%). Only 42.5% discussed CAM use with their physicians. Satisfaction with CAMS was recalled for 37.1% . The most common reason given for that satisfaction was improvement of emotional or physical well-being, while ineffectiveness was the most common reason given for dissatisfaction. The average cost of CAM during the last month of life was $US 900. CAM use was associated with longer disease periods, primary cancers other than liver, biliary, and pancreatic, and need of support from physicians or religion. CONCLUSIONS: CAM use among cancer patients at the EOL was common, not discussed with physicians, and associated with expectation of cure. Expectations were generally unmet while the treatments were a financial burden. Further studies evaluating the effects of CAM at the EOL and factors that enhance communication with the physician are needed.

Heart rate variability and obesity indices: emphasis on the response to noise and standing.

BACKGROUND: Obese people have a higher prevalence of cardiovascular disease, but the mechanism of this result remains obscure. The purpose of this study was to prove heart rate variability (HRV) response at rest and during stimuli in these persons. METHODS: The subjects were 41 healthy persons (19 men, 22 women) ranging in age from 20 to 65 years. HRV was measured at rest and at given stresses with noise and standing. RESULTS: Higher levels of fat mass, percentage fat content, and waist/hip ratio were significantly associated with lower low frequency (LF) (r = -0.34, r = -0.43; P < .01, r = -0.33, P < .05), and lower root mean square differences of successive NN intervals (RMS standard deviation) (r = -0.33, r = -0.35, r = -0.38, P < .05). During rest, noise, and standing, the change amount of the standard deviation of NN interval (SDNN) and low frequency/high frequency ratio were not different between normal and obese groups (P > .05). CONCLUSION: Although there was no significant HRV response to stimuli, root mean square of successive differences (which reflects parasympathetic acivity) and low frequency (which mainly reflects sympathetic activity) were negatively correlated with fat mass, fat percentage, and waist-to-hip ratio at rest in obese persons. These results mean obesity can change cardiac autonomic nervous response, meaning that the mechanism by which obesity increases cardiac mortality would be explained, at least partially.