The Blood Pressure Control Effect of the Sodium-Restricted Dietary Approaches to Stop Hypertension Diet: A Systematic Review.

The Dietary Approaches to Stop Hypertension (DASH) diet is highly effective in controlling blood pressure (BP). Although sodium restriction is not a primary focus within the DASH diet, it is recommended that it be added to control BP. Therefore, we aimed to systematically review the characteristics and BP-lowering effects of sodium-restricted DASH diet interventions. We searched 13 databases, namely, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, KoreaMed, KISS, KMbase, RISS, CINAHL, Scopus, ClinicalTrials.gov, Grey Literature Report, OpenGrey, and PQDT Global, for articles published through May 2023. Randomised controlled trials assessing the BP-lowering effect of the sodium-restricted DASH diet in adults aged 18 years and older were included. The study protocol was registered in the PROSPERO registry (CRD42023409996). The risk of bias in the included studies was also assessed. Nine articles were included in this review. Interventions were categorised into three types: feeding, provision, and education, and the study results were compared by intervention type. BP was significantly reduced in two of the three feeding studies, one of the three provisional studies, and none of the educational studies. In eight studies, effect sizes varied among both systolic BP (-7.7 to -2.4) and diastolic BP (-8.3 to 0.1). Six studies showed an overall high risk of bias. In conclusion, sodium-restricted DASH may have beneficial effects on BP control. Additionally, compared to control interventions, feeding interventions appeared to have a greater BP-lowering effect. Further high-quality studies are needed to improve the quality of the evidence.

Post-Stroke Depressive Symptoms: Varying Responses to Escitalopram by Individual Symptoms and Lesion Location.

OBJECTIVE: The efficacy of antidepressants in post-stroke depressive symptoms (PSD) varies. We aimed to examine whether the effect of escitalopram on PSD differs according to individual depressive symptoms and stroke lesion location. METHODS: This is a post hoc analysis of EMOTION (ClinicalTrials.gov, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram on depression in acute stroke patients (237 with placebo, 241 with escitalopram). Depressive symptoms were evaluated with the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Changes in MADRS and individual item scores at 12 weeks were compared between the treatment groups and among the stroke lesion location groups. Stroke lesion locations were grouped according to the anatomical distribution of serotonin fibers that originate from the midbrain/pons and spread to the forebrain via subcortical structures: "Midbrain-Pons," "Frontal-Subcortical," and "Others." Least-squares means were calculated to demonstrate the independent effect of lesion location. RESULTS: Total MADRS scores decreased more significantly in the escitalopram than in the placebo group, while a significant effect of escitalopram was observed in only 3 items: apparent sadness, reported sadness, pessimistic thoughts. In the lesion location analyses, escitalopram users in the Frontal-Subcortical group showed significant improvement in total MADRS scores (placebo [n = 130] vs. escitalopram [n = 148], least-square mean [95% CI]: -2.3 [-3.5 to -0.2] vs. -4.5 [-5.5 to -3.4], p = .005), while those in the Midbrain-Pons and Others groups did not. CONCLUSIONS: The effect of escitalopram on PSD may be more prominent in patients with particular depressive symptoms and stroke lesion locations, suggesting the need for tailored treatment strategies.

Are Genetic Variants Associated with the Location of Cerebral Arterial Lesions in Stroke Patients?

BACKGROUND: Genetic variants may play a role in determining the location of cerebral atherosclerosis. We aimed to investigate the association between RNF213, MMP2, and genetic polymorphisms linked to vascular tortuosity with the location of cerebral arterial atherosclerosis. METHODS: A prospective case-control study was conducted on patients with ischemic stroke and age- and sex-matched stroke-free controls. The stroke patients were categorized into those with intracranial artery atherosclerosis (ICAS), extracranial artery atherosclerosis (ECAS), and small vessel occlusion (SVO). Six single nucleotide polymorphisms (SNPs) including rs2118181 (FBN1), rs2179357 (SLC2A10), rs1036095 (TGFBR2), rs243865 (MMP2), rs1800470 (TGFB1), and rs112735431 (RNF213) were analyzed with the TaqMan Genotyping Assay, and the distribution of genotypes across groups was compared. RESULTS: None of the 6 SNPs were associated with stroke on comparing the 449 stroke patients (71 with ECAS, 169 with ICAS, and 209 with SVO) to the 447 controls. In the subgroup analysis, the adjusted odds ratios (aORs) for age and sex indicated a significant association between rs112735431 and ICAS in the allele comparison analysis and in the additive and dominant model analyses. rs112735431 was associated with anterior circulation involvement and increased burden of cerebral atherosclerosis. rs2179357 was significantly associated with ICAS in the recessive model analysis, and rs1800470 was significantly associated with ECAS in the recessive model analysis when compared to controls. CONCLUSION: rs112735431 was associated with ICAS and increased atherosclerosis burden in Korean stroke patients. Further studies are needed to elucidate the role of rs112735431 and to confirm the association of rs2179357 and rs1800470 with cerebral atherosclerosis.

Depressive Symptoms in Stroke Patients: Are There Sex Differences?

BACKGROUND: We aimed to examine sex differences in symptom characteristics and pharmacological responses in post-stroke depressive (PSD) symptoms. METHODS: This is a post hoc analysis of EMOTION (ClinicalTrials.gov, NCT01278498), a randomized, placebo-controlled, double-blind trial that examined the efficacy of escitalopram for 3 months on depression in patients with acute stroke. Depressive symptoms were evaluated using the 10-item Montgomery-Åsberg Depression Rating Scale (MADRS). Baseline characteristics, clinical variables, and treatment responses to escitalopram were compared between male and female patients. Treatment responses were defined as changes in MADRS (total score and its components) between baseline and 3 months and were compared between the escitalopram and placebo groups within each sex group. The least square mean was calculated to determine the independent effect of escitalopram, of which interaction was evaluated with patient sex. RESULTS: Of the 478 patients (intention-to-treat population), 187 (39%) were female. Female patients were significantly older than male patients and demonstrated more severe depressive symptoms at baseline (male vs. female, MADRS score, mean [SD]: 9.7 ± 8.0 vs. 12.2 ± 8.4, p = 0.001), especially in apparent sadness, reported sadness, and reduced appetite items. These differences were significant after adjustment for age and the severity of neurologic deficits. The female escitalopram group showed a significant 3-month improvement in MADRS scores (placebo [n = 86] vs. escitalopram [n = 101], least square mean [95% CI] -2.7 [-4.1 to -1.2] vs. -5.0 [-6.4 to -3.6], p = 0.007), and this efficacy was prominent in apparent sadness, reported sadness, and pessimistic thoughts items. However, there was no significant effect of escitalopram on depressive symptoms in the male group. The treatment responses of escitalopram tended to be more pronounced in the female group, particularly in alleviating a subset of depressive symptoms such as apparent sadness (p for interaction = 0.009). CONCLUSION: PSD may differ according to sex in its symptom characteristics and treatment responses to escitalopram, and tailored treatment strategies for PSD may therefore be needed.

Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association.

At least half of all stroke survivors experience fatigue; thus, it is a common cause of concern for patients, caregivers, and clinicians after stroke. This scientific statement provides an international perspective on the emerging evidence surrounding the incidence, prevalence, quality of life, and complex pathogenesis of poststroke fatigue. Evidence for pharmacological and nonpharmacological interventions for management are reviewed, as well as the effects of poststroke fatigue on both stroke survivors and caregivers.

Post-Stroke Fatigue May Be Associated with the Promoter Region of a Monoamine Oxidase A Gene Polymorphism.

BACKGROUND: Post-stroke fatigue (PSF) is a common sequela of stroke. Despite reports of serotonergic involvement in the etiology of PSF, the potential contribution of serotonergic genes in the development of PSF needs to be investigated. METHODS: A total of 373 patients, who experienced ischemic stroke for PSF, were evaluated 3 months after the stroke. PSF was assessed using the Fatigue Severity Scale. The genomic DNA collected and stored in a -70°C freezer was genotyped for 6 polymorphisms in genes associated with serotonin synthesis (tryptophan hydroxylase 1 (TPH1) A218C, TPH2 rs10879355, and TPH2 rs4641528), transport (the promoter region of the serotonin transporter protein), and catabolism (the 30-bp functional variable number tandem repeat) polymorphism in the promoter region of monoamine oxidase A (MAO-A). RESULTS: Among the 373 patients, 164 (44%) had PSF. All patients were ethnic Koreans. Of the 6 polymorphisms examined, only one marker, that is, low-activity MAO-A was associated with PSF (p < 0.05) in female patients. Multiple logistic regression analyses showed that post-stroke depression (PSD; 95% CI 1.561-14.323, p = 0.006) and low MAO-A activity (95% CI 0.166-0.722, p = 0.005) were factors associated with PSF in female patients, whereas only PSD (95% CI 5.511-65.269, p = 0.000) was associated with PSF in male patients. CONCLUSIONS: Our findings suggest that PSF may be associated with a genetic polymorphism involving MAO-A, at least in female stroke patients.

Sleep Disturbances at 3 Months after Cerebral Infarction.

BACKGROUND: Post-stroke sleep disturbances (PSSD) are common and associated with various adverse outcomes. However, PSSD in the sub-acute stages of stroke have been scarcely studied. We aimed to evaluate the characteristics of and the factors related to PSSD in stroke patients 3 months post stroke. METHODS: A total of 199 patients were evaluated for PSSD at 3 months after stroke. The qualities of nighttime sleep and excessive daytime sleepiness (EDS) were assessed using the Verran Snyder-Halpern sleep scale and Epworth Sleepiness Scale, respectively. Presence of motor dysfunction and post-stroke pain, post-stroke depression, fatigue and social support were evaluated. RESULTS: Eighty-eight patients (44.2%) had poor quality of nighttime sleep. Twenty-eight patients (14.4%) reported EDS. Poor quality of nighttime sleep was independently associated with depression (p = 0.044) and EDS (p = 0.041) whereas fatigue (p < 0.001) and poor nighttime sleep (p = 0.045) were independently associated with EDS. Post-stroke pain and social support showed no association with PSSD. CONCLUSIONS: We found that the occurrence of PSSD 3 months after stroke is common. Although causality remained to be determined, depression and nighttime sleep disturbances were related, whereas fatigue and nighttime sleep disturbances were related to EDS.

Poor dietary behaviors among hospital nurses in Seoul, South Korea.

BACKGROUND: Nurses reportedly practice unhealthy behaviors due to unfavorable work schedules. Korean nurses are particularly vulnerable to dietary and health behaviors due to high patient-to-nurse ratios; however, there are few studies on Korean hospital nurses' health behaviors. PURPOSE: To investigate the dietary and health behaviors of Korean hospital nurses according to their work schedule type. METHOD: This was a cross-sectional descriptive study using survey data from 340 hospital nurses. Nurses' dietary and health behaviors were evaluated across different work schedules and compared to the general Korean female population. RESULTS: Nurses with rotating night shift schedules were more often underweight than nurses without night shifts and had more unhealthy dietary behaviors, such as skipping breakfast and eating late night snacks. Nonetheless, Korean nurses practiced healthy behaviors, such as engaging actively in physical activity. CONCLUSIONS: Hospitals should create policies to provide healthy schedules for nurses to mitigate the negative effects of rotating and night shifts. However, these management-led measures will be effective only if individual nurses realize and take responsibility for their health behaviors and choices.

Health-promoting lifestyle behaviors and psychological status among Arabs and Koreans in the United Arab Emirates.

Cultural variations among ethnic groups may differentially influence health and health behavior. We explored and compared health-promoting lifestyle behaviors and psychological status, including depression, anxiety, and stress, among Korean migrants (n = 117) and Arab nationals (n = 103) in the United Arab Emirates (UAE). Pender's Health Promotion Model guided this research. The Health-Promoting Lifestyle Profile was used to measure health-promoting lifestyle behaviors and Lovibond and Lovibond's Depression, Anxiety, and Stress Scale to measure psychological status. The data were analyzed using bivariate procedures and multiple linear regression. No group differences were found in total scores for health-promoting lifestyle behaviors or psychological status. Both groups scored high on self-actualization and interpersonal support; Arabs scored low on exercise, and Koreans scored low on health responsibility. Across groups, psychological status (ß = -.390, p < .001), education (ß = .239, p < .001), and gender (ß = .238, p < .001) were significant determinants of health-promoting lifestyle behaviors in multivariate analysis. Ethnicity and religious attendance were not significant determinants. Education level had a moderating effect; for those with a lower educational level, psychological distress had a stronger negative effect on health behavior. Findings suggest considering cultural aspects, such as different values placed on physical fitness and social/interpersonal relationships, in developing and implementing health education and/or promotion programs. Assessment of psychological status (i.e., depression, anxiety, and stress) should also be included in health promotion programs and related health policies for Korean migrants and Arab nationals in the UAE.

Health behaviors of Korean female nursing students in relation to obesity and osteoporosis.

OBJECTIVES: It has been reported that young adults' dietary habits and health behaviors have significant effects on obesity and bone health. However, there is a lack of thorough understanding of the prevalence of unhealthy behaviors and potential relationships to obesity and osteoporosis among young females. METHODS: This cross-sectional study examined dietary habits, health behaviors, anthropometric measurements, and bone mineral density of 160 female nursing students. RESULTS: A relatively large number of students had vitamin D (n = 104, 65%) and calcium (n = 84, 52.5%) deficiencies but displayed excessive cholesterol (n = 86, 53.8%) and sodium (n = 137, 85.6%) intakes. Unhealthy dietary and health habits such as nighttime snacking, coffee drinking, low milk drinking, and lack of exercise were also noted. CONCLUSIONS: Despite their knowledge on health, a large portion of nursing students displayed unhealthy dietary habits and health. Tailored strategies and education to narrow the gap between health behavioral knowledge and practice are urgently needed.

Sleep disturbances after cerebral infarction: role of depression and fatigue.

BACKGROUND: Poststroke sleep disturbances (PSSDs) are frequent and reported to be associated with unfavorable clinical outcomes. PSSDs appear to be related to a multitude of factors including lesion location and environmental causes. Moreover, depression and fatigue, which frequently develop in stroke patients may also contribute to PSSD development. The purpose of this study was to evaluate the prevalence and characteristics of PSSDs and factors related to PSSDs including depression and fatigue in hospitalized stroke patients. METHODS: Patients who were hospitalized with acute stroke at the Asan Medical Center were evaluated. The quality (Verran-Snyder-Halpern [VSH] Sleep Scale score), duration and latency of night-time sleep, the frequency of waking after sleep onset, and daytime sleepiness were evaluated during the hospitalization period. To validate the self-reported night-time sleep, an actigraphy was performed in a subset of patients. The location, circulation, and laterality of each lesion were determined from brain magnetic resonance images obtained within 7 days of stroke onset. Depression and fatigue were assessed using the Beck Depression Inventory and the Fatigue Severity Scale, respectively. For environmental factors, the duration of hospitalization and the number of other patients in the same room were recorded. Univariate, multiple regression, and multiple logistic regression analyses were used to evaluate predictors of PSSD development. RESULTS: A total of 282 patients completed the study. The mean age of the patients was 62.3 (±12.76) years and 58.9% of them were male. Sixty patients (21.3%) reported sleep duration less than 6 hours/night and 110 (39.0%) reported more daytime sleepiness than before the stroke. In 54 patients who agreed to wear an actigraph, self-reported sleep duration was significantly correlated with time in bed measured with an actigraph (r = .407, P = .002) and, VSH Sleep Scale score and sleep efficiency in actigraphy were also significantly correlated (r = .305, P = .026). Quality of night-time sleep was independently related to cortical lesion location (P = .002), diabetes mellitus (P = .020), and depression (P < .001), whereas increased daytime sleepiness was independently associated with subcortical lesion location (P = .031), fatigue (P = .001), and quality of night-time sleep (P = .001). CONCLUSIONS: PSSDs are common in hospitalized stroke patients. The most powerful factor predicting night-time sleep disturbances in stroke patients was depression. Cortical brain lesion and diabetes mellitus were also associated with night-time sleep disturbances. On the other hand, although poststroke daytime sleepiness is in part caused by night-time sleep disturbance, it is more closely associated with fatigue and subcortical lesion location.

Dietary behavior and its influencing factors among experienced shiftwork nurses: a secondary analysis.

PURPOSE: This study investigated the dietary behavior of experienced shiftwork nurses and aimed to identify factors related to dietary behavior. METHODS: This study was a secondary analysis based on the Shift Work Nurses' Health and Turnover study (2018-2021) among Korean nurses. In total, 247 experienced (>12 months) shiftwork nurses were included in this study. The participants' dietary behavior, depression, level of occupational stress, fatigue, physical activity, and general characteristics were measured. Descriptive statistics, Pearson correlation coefficients, independent t-test, one-way analysis of variance, the Kruskal-Wallis test, and multiple regression analysis were conducted. RESULTS: The dietary behavior score of the participants using the Mini-Dietary Assessment Index was 29.35±5.67. Thirty percent of the participants were depressed, the participants experienced moderate occupational stress, and 74.1% of the participants engaged in an inadequate amount of physical activity. The factors influencing shiftwork nurses' dietary behavior were having child(ren) (ß=.16, p=.027), depression (ß=-.13, p=.032), level of occupational stress related to occupational climate (ß=-.13, p=.035), and an inadequate amount of physical activity (ß=-.17, p=.006). These factors explained 10.4% of the variance in experienced shiftwork nurses' dietary behavior scores. CONCLUSION: Experienced nurses with child(ren) tended to have healthier diets. However, a higher level of occupational stress related to occupational climate, depression, and engaging in an inadequate amount of physical activity were associated with a higher risk of having an unhealthy diet. Therefore, strategies are needed to encourage physical activity and alleviate adverse occupational climate and depression among experienced nurses.

Depressive symptoms and functional impairment among amyotrophic lateral sclerosis patients in South Korea.

PURPOSE: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease, resulting in physical and psychological distress. Little is known about the health of ALS patients in South Korea. The purpose of this study was to assess the degree of functional impairment and depressive symptoms and their interrelationships in Korean ALS patients. METHOD: In this cross-sectional descriptive study, a convenience sample of 62 ALS patients was recruited. Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) and Beck Depression Inventory (BDI) were used. RESULTS: The mean score of ALSFRS was 18.98 and 24.50 for BDI. Severity of depressive symptoms was associated with gender, employment, perceived health status, and ALS type. A greater functional impairment was associated with greater depressive symptoms. CONCLUSIONS: This study reports high prevalence of depressive symptoms in ALS patients. The findings add to the body of knowledge on emotional health and provide motives for interventions to promote mental health of these patients.

Health problems, turnover intention, and actual turnover among shift work female nurses: Analyzing data from a prospective longitudinal study.

AIMS: This study investigated health problems, turnover intention, and actual turnover among shift work nurses. While turnover intention is often used as a proxy variable for turnover, the relationship between these variables requires clarification. This study tested for relevant associations using prospective longitudinal data with a time lag of 12 months. We also tested for associations between health problems (sleep disturbance, fatigue, and depression) and turnover intentions/turnover, with a focus on the mediating role of turnover intention. METHODS: This study conducted a secondary analysis of data from the Shift Work Nurses' Health and Turnover project, which is a prospective longitudinal cohort study. We analyzed health problems, turnover intention, and actual turnover. The data were analyzed via descriptive statistics, the Pearson's chi-squared test, independent t-test, univariable logistic regression, multiple logistic regression, and causal mediation. RESULTS: Participants included 491 shift work female nurses. Of these, 112 (22.8%) had turnover intention, while 38 (7.7%) left their jobs within the 12-month period of investigation. Of the 112 with turnover intention, 22 left their jobs (OR 5.68. 95% CI 2.84-11.36). The logistic regression analysis showed that sleep disturbance and fatigue were associated with turnover intentions and actual turnover, while depression was only associated with turnover intention. The causal mediation analysis showed that turnover intention mediated the relationship between health problems (sleep disturbance and fatigue) and actual turnover (sleep disturbance OR 1.31, 95%CI = 1.02-1.60; fatigue OR 2.11, 95%CI = 1.50-2.68); sleep disturbance had a natural direct effect on actual turnover (OR 2.66, 95%CI,2.07-3.21). CONCLUSION: Turnover intention strongly predicted actual turnover. Sleep disturbances may result in turnover, even in cases without existing turnover intention. These findings highlight the need for early interventions aimed at preventing and alleviating sleep disturbances for shift work female nurses.

Anger, a Result and Cause of Stroke: A Narrative Review.

Post-stroke mood and emotional disturbances are frequent and diverse in their manifestations. Among them, post-stroke depression is the best known. Although post-stroke anger (PSA) has been studied relatively less, it can be as frequent as depression. Manifestations of PSA range from overt aggressive behaviors (including hitting or hurting others) to becoming irritable, impulsive, hostile, and less tolerable to family members. The possible pathophysiological mechanisms of PSA include neurochemical dysfunction due to brain injury, frustration associated with neurological deficits or unfavorable environments, and genetic predisposition. PSA causes distress in both patients and their caregivers, negatively influences the patient's quality of life, and increases the burden on caregivers. It can be treated or prevented using various methods, including pharmacological therapies. In addition, anger or hostility may also be a risk or triggering factor for stroke. The hazardous effects of anger may be mediated by other risk factors, including hypertension or diabetes mellitus. The identification of anger as a result or cause of stroke is important because strategic management of anger may help improve the patient's quality of life or prevent stroke occurrence. In this narrative review, we describe the phenomenology, prevalence, factors or predictors, relevant lesion locations, and pharmacological treatment of PSA. We further describe the current evidence on anger as a risk or triggering factor for stroke.

Leisure time physical activity in patients with epilepsy in Seoul, South Korea.

The aim of this study was to investigate the frequencies of and barriers to leisure time physical activity (LTPA) of people with epilepsy (PWE), and influencing factors, particularly those related to mood. Data were obtained from 178 PWE who visited the Seoul National University Hospital outpatient clinic in January and February 2007. Most PWE reported not being involved in LTPA as much as they wished. PWE reported hiking (n=32, 18%) and walking (n=25, 14%) as the most common LTPA. Many PWE identified epilepsy-specific barriers such as "the fear of experiencing seizures during activity" and "discouragement from activity by family and/or friends." In multiple logistic regression analysis, PWE who were on antiepileptic drug polytherapy (OR=2.49, 95% CI=1.22-5.08, P=0.01), had anxiety (OR=3.25, 95% CI=1.22-8.60, P=0.02), and had had previous seizure experiences during activities (OR=2.84, 95% CI=1.30-6.20, P=0.01) were significantly more likely to be inactive. Educational programs for reducing anxiety and misunderstanding about activity of PWE and guidelines for promoting LTPA among PWE are needed.

Physical and Mental Health Related Quality of Life and Their Influencing Factors on Sexual Minority Women in Korea.

Korean sexual minority women (SMW) often experience discrimination, but their health-related quality of life (HRQoL) remains to be investigated. Therefore, we aimed to assess the levels of mental and physical HRQoL of Korean SMW and their influencing factors using data from the Korean Sexual Minority Women's Health Study (2017) in a cross-sectional study, which included lesbian and bisexual females (N = 736; age ≥19 years). The HRQoL was measured using SF-36v2®; moreover, separate multiple linear regression analyses were conducted to identify the factors influencing mental and physical HRQoL. The physical and mental HRQoL scores were average (52.38 ± 7.65) and low (38.33 ± 12.64), respectively. Significant factors influencing the physical HRQoL were bisexuality, minority stress, perceived social support, and physical activity. The same factors-apart from physical activity-were associated with mental HRQoL. Therefore, to improve the HRQoL of SMW, it is necessary to lower their minority stress and increase social support. Moreover, special attention is needed regarding bisexual women in Korea.

Infection Prevention Performance among In-Flight Cabin Crew in South Korea.

COVID-19 was declared a worldwide pandemic in 2020; thus, preventing in-flight infection transmission is important for stopping global spread via air travel. Infection prevention (IP) performance among aircraft cabin crew is crucial for preventing in-flight transmission. We aimed to identify the level of IP performance and factors affecting IP performance among aircraft cabin crew during the COVID-19 pandemic in South Korea. An online survey was conducted with 177 cabin crew members between August and September 2020. The survey assessed IP performance, and IP awareness, using a five-point Likert scale, and also evaluated simulation-based personal protective equipment (PPE) training experience, and organizational culture. The average IP performance score was 4.56 ± 0.44. Although the performance level for mask-wearing was high (4.73 ± 0.35), hand hygiene (HH) performance (4.47 ± 0.56) was low. Multivariate analysis showed that IP performance was significantly associated with IP awareness (p < 0.05) and simulation-based PPE training experience (p < 0.05). Since HH performance was relatively low, cabin crew and airlines should make efforts to improve HH performance. Furthermore, a high level of IP awareness and PPE training experience can improve IP performance among cabin crew members. Therefore, simulation-based PPE training and strategies to improve IP awareness are essential for preventing in-flight infection transmission.

Scheduled Naps Improve Drowsiness and Quality of Nursing Care among 12-Hour Shift Nurses.

Scheduled naps in the workplace are an effective countermeasure to drowsiness in safety-sensitive industries. This quasi-experimental study with a one-group, pre- and post-test design aimed to examine the effects of scheduled naps on nurses working 12-h shifts. Nurses in two pediatric intensive care units at a tertiary hospital were provided 30-min scheduled nap opportunities during their shifts. A total of 38 nurses completed pre- and post-test work diaries for sleepiness, fatigue, work demands and pace, and quality of nursing care at the end of each shift. The drowsiness of 13 nurses was continuously assessed during their shifts using infrared reflectance oculography. Nurses who reached naps reported improved levels of fatigue on the first night shift and better quality of nursing care the second night and day shifts post-test, while nurses who did not reach naps showed no significant improvements. The oculography successfully assessed drowsiness during 73% and 61% of the pre- and post-test total work hours, respectively. The total cautionary and cautionary or higher levels of drowsiness decreased. Nurse managers should consider scheduled naps in clinical settings to improve nurses' alertness during their shifts.