The effect of support surface on the prevention of pressure injury in acute care settings: A multi-center prospective observational study.

PURPOSE: This study aimed to analyze if a multi-foam core mattress with a laminated cover can reduce the incidence of pressure injuries, compared to an alternating air mattress overlay among critically ill patients in acute settings. DESIGN: Prospective observational study. PARTICIPANTS: and setting: Patients with a Braden scale score ≤16 on intensive care unit admission at five general hospitals in Korea were included in this study between February 2022 and March 2022. METHODS: One hundred and twenty patients in acute settings were enrolled and categorized into two groups: a multi-form core mattress with a laminated cover group (n = 60) and an alternating air mattress overlay group (n = 60). Data were collected for 7 days by wound care nurses. RESULTS: Pressure injury developed at a significantly lower rate in the multi-form core mattress with a laminated cover group (n = 4/60, 6.7 %) than in the alternating air mattress overlay group (n = 25/60, 25.0 %) (P = 0.011). Using a multi-foam core mattress with a laminated cover demonstrated a protective effect against pressure injuries (odds ratio 0.123, 95 % confidence interval 0.024-0.620, P = 0.011). CONCLUSIONS: A multi-foam core mattress with a laminated cover was significantly more effective than an alternating air mattress overlay in preventing pressure injury in critically ill patients.

Breastfeeding mobile application for mothers with gestational diabetes mellitus: designed by mothers and experts.

BACKGROUND: Mothers and babies with gestational diabetes have an increased risk of diabetes, obesity, and cardiovascular complications. Breastfeeding is known to help reduce complications in mothers and babies with gestational diabetes. However, the rate of breastfeeding among mothers with gestational diabetes is still low due to various barriers. Therefore, the purpose of this study was to develop a mobile application to improve the breastfeeding barrier of pregnant women with gestational diabetes. METHODS: The Method of App Selection based on Users' Needs is a method used in designing app structure and user interface by considering user needs. This method was used to develop the Breastfeeding for Gestational Diabetes Mellitus App, reflecting the needs of target users. Four personas were created based on the experiences of four mothers with gestational diabetes mellitus, and these personas' needs were assessed and prioritized. Two professors and a clinical instructor in women's health nursing conducted an expert review and revised the contents. RESULTS: Our "Breastfeeding for Gestational Diabetes Mellitus App" included the following components to promote breastfeeding in mothers with gestational diabetes mellitus: baby growth, breastfeeding records, information about mothers with gestational diabetes mellitus, information about breastfeeding, videos demonstrating breastfeeding methods and breast massage techniques, breastfeeding success stories, a message board, a section for frequently asked questions and answers, and links to breastfeeding education centers. CONCLUSIONS: Use of our App is expected to help prevent complications in mothers with diabetes mellitus and their babies and to promote maternal and child health through improved breastfeeding practices, especially in social distancing situations resulting from COVID-19.

The use of sub-epidermal moisture measurement in predicting blanching erythema in jaundice patients.

OBJECTIVE: To investigate the relationship between sub-epidermal moisture (SEM) and visual skin assessment (VSA) in pressure ulcers (PU) patients with jaundice in Korea. METHOD: This is a longitudinal observational study. Data was collected by a wound care nurse, at a tertiary hospital, for six weeks beginning in June 2013. Once a week for the six weeks, the nurse assessed VSA and measured SEM, for each subject, on seven anatomical sites (both buttocks, both ischial tuberosities, both trochanters, and the sacral coccyx), using a NOVA Petite dermal phase meter for SEM. The measurements ranged from 0 to 999, and higher SEM indicates higher water content in the tissue. RESULTS: There were 22 adults participated in the study. The SEMs in category I PU were significantly higher than those in patients who had no injury, or blanching erythema. The SEM difference between category I PU and either blanching erythema or no injury was more than 60 points at the sacral coccyx, and the difference between blanching erythema and no PU was more than 100 points at the trochanters. After the covariates were adjusted for, the odds ratios (ORs) for blanching erythema were statistically significant. The ORs for blanching erythema versus normal skin was 1.016 higher than the concurrent SEMs. Also, The ORs of 1-point concurrent SEMs for blanching erythema versus normal skin at Sacral coccyx, right and left ischial tuberosity and left trochanter were 1.015, 1.128, 1.137 and 1.051 respectively (p<0.05). CONCLUSION: SEM was associated with concurrent early skin damage, specifically blanching erythema with jaundice. Therefore, SEM may be used to predict early skin damage in patients with jaundice in clinical nursing for effective PU prevention and management.

Knowledge and health beliefs about gestational diabetes and healthy pregnancy's breastfeeding intention.

AIMS AND OBJECTIVES: If the knowledge and health beliefs relating to gestational diabetes mellitus during pregnancy are associated with behaviours during pregnancy and lactation, this suggests potential educational interventions. BACKGROUNDS: Women with gestational diabetes mellitus are more likely to develop type 2 diabetes mellitus, and babies with gestational diabetes mellitus incur increased risk of neonatal hypoglycaemia and childhood obesity. Breastfeeding is an effective way to improve maternal and lipid metabolism of gestational diabetes mothers, and to lower the risk of type 2 diabetes mellitus after birth, to prevent conception. Nurses have an important role in encouraging mothers to breastfeed for health promotion. The importance of cognitive factors such as knowledge, beliefs and attitudes is emphasised to increase the breastfeeding rate and to improve the quality of breastfeeding for pregnant women. Little research has been undertaken exploring cognitive factors and breastfeeding intention. DESIGN: Cross-sectional descriptive survey in healthy pregnant women. METHODS: A questionnaire about gestational diabetes mellitus-related knowledge and health beliefs of gestational diabetes mellitus management composed of perceived susceptibility, severity, benefits, barriers and self-efficacy was developed by investigators. The association of two predictor variables of interest, gestational diabetes mellitus-related knowledge and health beliefs of gestational diabetes mellitus management, was tested with the outcome variable, breastfeeding intention, using chi-square test, t test, ANOVA and multiple logistic regression. RESULTS: Two hundred and thirty-seven of the 250 participants returned questionnaires for a final response rate of 94.8%. Breastfeeding intention after childbirth was associated with stronger perceived benefit, higher levels of self-efficacy and lower alcohol consumption. CONCLUSION: History of drinking and health beliefs such as perceived benefits and self-efficacy were highly associated with breastfeeding intention relating to gestational diabetes mellitus. Education for breastfeeding in gestational diabetes mellitus mothers should focus upon the benefit of breastfeeding and strengthening self-efficacy.

The relationship of subepidermal moisture and early stage pressure injury by visual skin assessment.

AIM: The purpose of this study was to examine the relationship of subepidermal moisture and early stage pressure injury by visual skin assessment in elderly Korean. METHODS: Twenty-nine elderly participated at a particular nursing home. Data were collected for 12 weeks by one wound care nurse. Visual skin assessment and subepidermal moisture value were measured at both buttocks, both ischia, both trochanters, sacrum, and coccyx of each subject once a week. RESULTS: Subepidermal moisture value of stage 1 pressure injury was significantly higher than that of no injury and blanching erythema. After adjustment with covariates, odds ratios of blanching erythema to normal skin and stage 1 pressure injury to blanching erythema/normal skin were statistically significant (p < 0.05). Odds ratio of blanching erythema to normal skin was 1.003 (p = .047) by 1-week prior subepidermal moisture value, and that of concurrent subepidermal moisture value was 1.004 (p = .011). Odds ratio of stage 1 pressure injury to normal skin/blanching erythema was 1.003 (p = .005) by 1-week prior subepidermal moisture value, and that for concurrent subepidermal moisture value was 1.007 (p = .030). Subepidermal moisture was associated with concurrent and future (1 week later) skin damage at both trochanters. CONCLUSION: Subepidermal moisture would be used to predict early skin damage in clinical nursing field for the effective pressure injury prevention.

Prevention of Zika virus infection: Knowledge, attitudes, and practices of pregnant women in Korea.

This study was performed to investigate the association of knowledge, attitudes, and preventive practices for the prevention of Zika virus infection. The study sample consisted of 185 pregnant women in Korea. The Zika virus-related knowledge and attitude of pregnant women significantly affected preventive practices. The younger pregnant women and pregnant women who had not taken the influenza vaccine had lesser preventive practices of the Zika virus, thereby necessitating educating them and emphasizing good preventive practices. Our results suggest that systematic education and effective prevention programs for Zika virus will contribute to the prevention of infection.

A study on the predictors of Korean male students' intention to receive human papillomavirus vaccination.

AIMS AND OBJECTIVES: The objective was to survey the current state of human papillomavirus (HPV) vaccination and the predictors of vaccination intention among Korean male students of high school (ages 15-19) and university (ages 17-27). BACKGROUND: Human papillomavirus is a sexually transmitted infectious agent causing uterine cervical, anal, and/or penile cancer and genital warts in males and females. Infection rate of human papillomavirus increases from the age when sexual intercourse first occurs. Therefore, motivation to receive human papillomavirus vaccination is needed to protect infection. DESIGN: Cross-sectional descriptive survey was performed only in male students. They are less aware of human papillomavirus than females, because human papillomavirus vaccination has been targeted on females for preventing cervical cancer in Korea. METHODS: Data were collected using a self-reporting questionnaire for male high school and university students sampled from a city in Korea. Human papillomavirus vaccine-related knowledge, health beliefs, demographic, and sexual history information variables relating to intentions to vaccinate were assessed. RESULTS: The human papillomavirus vaccination rate was very low and the levels of knowledge and health beliefs were low. The significant predictors that raised the intention of human papillomavirus vaccination were a university student, experience of sexual intercourse and perceiving the benefits of human papillomavirus vaccination. CONCLUSIONS: To promote human papillomavirus vaccination, educational programming targeting males should include health beliefs and knowledge, emphasising that vaccination is important to prevent uterine cervical cancer and to role as a preventative measure against common male diseases. RELEVANCE TO CLINICAL PRACTICE: Male high school students should be included as a major target population for school human papillomavirus education programmes, as they are at the age of commencing sexual intercourse. In addition, public health policies including human papillomavirus vaccination in the national immunisation programme are warranted.

[Development and Effectiveness Evaluation of Comprehensive Mobile-Based, Breastfeeding Promotion Program for Mothers with Gestational Diabetes].

PURPOSE: This study aimed to evaluate the effects of a mobile-based breastfeeding promotion program (M-BFGDM) that helps mothers with gestational diabetes. METHODS: Forty-seven mothers participated in the study, of whom 22 were in the experimental group and 25 in the control group. To verify the effects, a lag design before and after the non-equivalence control group was used. The data collection for the experimental group was done before and after the intervention. RESULTS: In the results, breastfeeding knowledge showed a significant difference in the interaction between measurement period and group (χ² = 8.14, p = .017), whereas breastfeeding intention did not show a significant difference in the interaction (χ² = 4.73, p = .094). There was no difference in self-efficacy interaction (F = 0.13, p = .856). The breastfeeding method showed no difference in interaction (F = 0.04, p = .952), whereas cross-analysis showed a significant difference in breastfeeding practice rate between the experimental group and the control group at 1 month postpartum (χ² = 7.59, p = .006). CONCLUSION: A mobile-based breastfeeding promotion program was developed and applied for gestational diabetic mothers, resulting in an increase in breastfeeding knowledge and an improvement in breastfeeding practice rate one month after childbirth. In addition, M-BFGDM managed to create a breastfeeding practice environment with fewer time and place restrictions. A program study that complements motivation is needed to improve breastfeeding in pregnant diabetic mothers in the future.

Patient Safety in Nursing Homes From an Ecological Perspective: An Integrated Review.

OBJECTIVES: The aims of the study were to identify the systemic factors affecting the characteristics and safety of older adults living in nursing homes and the resulting resident outcomes and to explore the relationship between them through an integrated literature review. METHODS: A literature search was conducted from April 22 to May 6, 2021, in the PubMed, Embase, Cochrane CENTRAL, CIHNAL, RISS, NDL, and KoreaMed databases. The following key words and MeSH terms were used for the search: "nursing home," "skilled nursing facility," "long-term care facility," and "patient safety" or "safety." RESULTS: Forty-seven qualifying articles were finally selected. Three domains were derived as personal factors, 12 as facility factors, and one as a policy factor. The interrelationships between them could result in positive or negative resident outcomes. The relationship between them was also reconstructed from an ecological perspective. CONCLUSIONS: The results demonstrated that the safety and quality of life of older adults living in nursing homes were affected by both individual and institutional factors.

Knowledge and Visual Differentiation Ability of the Pressure Injury Classification System and Incontinence-Associated Dermatitis among Hospital Nurses: A Descriptive Study.

This study investigated clinical nurses' knowledge and visual differentiation ability of the pressure injury classification system (PICS) and incontinence-associated dermatitis (IAD), additionally analyzing possible influencing factors. A convenience sample of 248 nurses took the PICS and IAD knowledge test (KT) and completed the visual differentiation ability test (VDAT), consisting of 21 photographs with clinical information. The overall mean score for correct answers was 12.65 ± 2.90 points in PICS and IAD KT and 11.43 ± 4.57 points in VDAT. Incorrect responses were most common for statements related to stage II, III, IAD for PICS and IAD KT, and deep tissue pressure injury (DTPI), unstageable, and stage III for VDAT. Significant correlations were found between PICS and IAD KT and VDAT (r = 0.252, p < 0.001). Factors affecting scores for VDAT were the scores of PICS and IAD KT, debridement experience in nursing patients with PI, and the management frequency of PI and IAD. Results indicate that nurses have an overall understanding of PICS and IAD, but low visual differentiation ability regarding stage III, DTPI, and unstageable PI. Continuing education is needed to further improve knowledge and visual differentiation ability for PICS and IAD.

Awareness and practice of wound disinfection among wound care nurses in Korea.

PURPOSE: The aim of this study was to assess the awareness and practice of wound disinfection among Korean wound care nurses. SUBJECTS AND SETTING: The target sample comprised 100 members of the Korea Wound Ostomy Continence Nurse Association. Seventy-eight wound care nurses responded to the questionnaire, yielding a response rate of 78%. METHODS: Potential respondents were contacted via e-mail and asked to complete a questionnaire designed for this study. RESULTS: Pressure ulcers were the most common wound type managed by WOC nurses, followed by surgical wounds. The mean score of items measuring awareness of wound disinfection practice and reported wound disinfection practice were 3.38 on a scale of 0 to 4 scale, and 3.14 on a scale of 0 to 4, respectively. Scores among items that queried awareness and practice in various methods for disinfecting a chronic wound disinfection were highest (3.74 and 3.67 out of 4, respectively) and scores of items querying disinfection with sodium hypochlorite were lowest (2.80 and 2.05 out of 4, respectively). There were significant differences between all items of awareness and reported practice except for disinfection with alcohol. Awareness of wound disinfection significantly correlated with reported practice. CONCLUSIONS: Developing an effective educational program to enhance awareness is necessary to improve practice of wound disinfection.

Machine Learning-Based Prediction of Abdominal Subcutaneous Fat Thickness During Pregnancy.

Objective: Current evidence regarding the safety of abdominal subcutaneous injections in pregnant women is limited. In this study, we developed a predictive model for abdominal skin-subcutaneous fat thickness (S-ScFT) by gestational periods (GP) in pregnant women. Methods: A total of 354 cases were measured for S-ScFT. Three machine learning algorithms, namely deep learning, random forest, and support vector machine, were used for S-ScFT predictive modeling and factor analysis for each abdominal site. Data analysis was performed using SPSS and RapidMiner softwares. Results: The deep learning algorithm best predicted the abdominal S-ScFT. The common important variables in all three algorithms for the prediction of abdominal S-ScFT were menarcheal age, prepregnancy weight, prepregnancy body mass index (categorized), large fetus for gestational age, and alcohol consumption. Conclusion: Predicting the safety of subcutaneous injections during pregnancy could be beneficial for managing gestational diabetes mellitus in pregnant women.

Preventive Behavior Intentions for Polycystic Ovary Syndrome in Young Students.

Objective: Polycystic ovary syndrome (PCOS) is among the most common, yet treatable causes of infertility. This study explored how South Korean female college students' health beliefs and knowledge of PCOS are associated with their preventive behavior intentions. Methods: Data for this cross-sectional study were collected using an online survey of 328 female university students from July 25 to August 30, 2020. Data were analyzed using the chi-squared test and t-test, Pearson's r, and hierarchical multiple regression analysis. Results: The average age of participants was 21.67 years, 7.3% of whom had been diagnosed with PCOS. Perceived disability (ß = 0.30, P < 0.001) and perceived benefit (ß = 0.26, P < 0.001) of health behavior were associated with preventive behavior intentions. However, knowledge was not a significant factor. Conclusions: Health beliefs are related to the preventive behavior intentions of women with PCOS. Education to strengthen health beliefs should be provided to female university students.

Cancer Screening Program Delivered by Community Health Workers for Chinese Married Immigrant Women in Korea.

This quasi-experimental study used a cancer prevention program delivered by community health workers (CHWs) as an intervention to improve health literacy and increase screening uptake. The intervention group was educated by trained CHWs and received information about the nearby hospitals. After education, participants received telephone counseling once a month for 6 months. In the intervention group, CHWs met the participants individually and delivered the CD-ROM containing conversation scenarios with voice during the cancer screening test. The control group was provided educational materials related to breast and cervical cancers and a booklet containing information on mammography and Pap test. This study assessed the difference in mammography and Pap tests between the intervention and control groups. The results showed that the participants' knowledge improved, and the rate of cancer screening tests did not decrease in the intervention group. Therefore, it is necessary to develop and apply various programs that train CHWs and apply them to immigrant women to promote health-related behaviors under the health system that they are not familiar with while living in another country.

Comparison of metabolic syndrome and related factors in married pre-menopausal white- and blue-collar woman.

This study aimed to identify the prevalence and associated factors of metabolic syndrome in pre-menopausal married women with white-collar and blue-collar jobs. This study analyzed 4,447 women with jobs in the Korean National Health and Nutrition Examination Survey (2010-2018). The prevalence of metabolic syndrome was higher among blue-collar women (15.3%) than among white-collar women (10.5%). Age, family type, alcohol consumption, frequency of high-risk drinking, perceived health status, and body mass index (BMI) were significantly associated with metabolic syndrome in the white-collar (p < .05). Age, family type, frequency of eating out, and BMI were associated in the blue-collar (p < .05). Blue-collar women were more vulnerable to metabolic syndrome than white-collar ones. To prevent metabolic syndrome in pre-menopausal married women with jobs, lifestyle modifications such as mitigating obesity and reducing alcohol consumption with aging are necessary.

The Effects of Academic Stress and Upward Comparison on Depression in Nursing Students during COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has created a global long-term education crisis, which has negatively affected the psychological well-being of nursing students. This study aims to determine the effect of academic stress and upward comparison on depression among nursing students during the COVID-19 pandemic. A convenience sample of 271 junior and senior nursing students from four universities in South Korea was selected. The SPSS/WIN 28.0 program was employed for the data analysis, and multiple regression analysis was performed to confirm the effect of academic stress and stress from upward comparison on depression. The study results show that the regression model was significant (F = 7.60, p < 0.001). Moreover, age over 25 (ß = 0.15, p = 0.006), academic stress (ß = 0.31, p < 0.001), and upward comparison (ß = 0.18, p = 0.002) explained 19.0% of depression among the participants. Developing and testing the effect of programs that address academic stress and upward comparison may be necessary to control depression in nursing students. Furthermore, in response to COVID-19, efforts must be made to include these interventions in the curriculum for nursing students on a consistent basis.

Therapeutic efficacy of halocidin-derived peptide HG1 in a mouse model of surgical wound infection with methicillin-resistant Staphylococcus aureus.

We evaluated the therapeutic potential of HG1, an antimicrobial peptide, as a novel topical antibiotic by the use of a mouse surgical wound model of infection with methicillin-resistant Staphylococcus aureus. First, we attempted to determine whether or not HG1 infiltrated into the dermis when topically administered. Second, we evaluated the antibiotic effects of HG1 on skin infection via bacterial-enumeration and microscopic analyses. The results showed that topically administered HG1 was capable of penetrating into the dermis at the infection site, where it exerted its antimicrobial effects.

Factors Associated with the Need for Breastfeeding Information Among Women with Gestational Diabetes Mellitus: A Cross-sectional Study.

PURPOSE: Analyzing information based on individual needs can maximize the effectiveness of education, leading to changes in personal health behaviors. This cross-sectional descriptive survey study aimed to identify the characteristics of mothers who experienced gestational diabetes mellitus and correlate the factors associated with their information needs. METHODS: The participants were 298 women between the ages of 20 and 49 years who were pregnant and diagnosed with gestational diabetes at the time of the study, or who were diagnosed with gestational diabetes mellitus within five years after delivery. The average age of the participants was 34.28 years. After comparing participants' demographics, diabetes, and breastfeeding-related characteristics according to their need for information on breastfeeding, a multiple logistic regression analysis was performed. RESULTS: Factors associated with participants' need for information on breastfeeding were economic conditions, usual body mass index, current pregnancy, and experience of breastfeeding. CONCLUSION: The findings can be used to implement programs that meet the needs of these women and help improve maternal and pediatric health and quality of life.

A comparative study of cumulative stress patterns within 14 days postpartum in healthy mothers and those with gestational diabetes: A prospective study.

ABSTRACT: Although the number of mothers with gestational diabetes mellitus (GDM) is on the rise, only few studies have examined the cumulative stress associated with breastfeeding after childbirth. GDM mothers are susceptible to stress due to insulin resistance, and their level of stress is associated with breastfeeding. This study aimed to identify patterns of stress change over time in GDM mothers and healthy mothers and to identify the factors influencing those patterns.The participants of this study were mothers within 14 days after childbirth. The GDM group consisted of 32 mothers, and the healthy group comprised 30 mothers. Cumulative stress was measured in terms of heart rate variability, and linear mixed models were used to analyze changes over time.The cumulative stress of healthy mothers was about 8 points higher than that of mothers with GDM (t = -2.95, P = .005). The cumulative stress level was inversely associated with the mother's age (ß=-1.20, P = .018), the mother's weight (ß=-0.64, P = .008), and the baby's body mass index (ß=-3.09, P = .038). Furthermore, an insufficient amount of breast milk was associated with higher stress (ß=16.09, P = .007).GDM mothers and healthy mothers experienced different patterns of cumulative stress. Breastfeeding should be started quickly to promote health and stress reduction among mothers who are physically and psychologically vulnerable after childbirth.It is necessary to incorporate programs to promote breastfeeding considering stress levels at an appropriate time according to the mother's health condition.

Antimicrobial activity of a halocidin-derived peptide resistant to attacks by proteases.

Cationic antimicrobial peptides (AMPs) have attracted a great deal of interest as a promising candidate for a novel class of antibiotics that might effectively treat recalcitrant infections caused by a variety of microbes that are resistant to currently available drugs. However, the AMPs are inherently limited in that they are inevitably susceptible to attacks by proteases generated by human and pathogenic microbes; this vulnerability severely hinders their pharmaceutical use in human therapeutic protocols. In this study, we report that a halocidin-derived AMP, designated HG1, was found to be resistant to proteolytic degradation. As a result of its unique structural features, HG1 proved capable of preserving its antimicrobial activity after incubation with trypsin, chymotrypsin, and human matrix metalloprotease 7 (MMP-7). Additionally, HG1 was observed to exhibit profound antimicrobial activity in the presence of fluid from human skin wounds or proteins extracted from the culture supernatants of Staphylococcus aureus and Pseudomonas aeruginosa. Greater understanding of the structural motifs of HG1 required for its protease resistance might provide feasible ways to solve the problems intrinsic to the development of an AMP-based antibiotic.