Risk and Risk Factors for Postpartum Type 2 Diabetes Mellitus in Women with Gestational Diabetes: A Korean Nationwide Cohort Study.

BACKGROUND: There are differences in risk and risk factor findings of postpartum type 2 diabetes mellitus (T2DM) after gestational diabetes depending on study design and subjects of previous studies. This study aimed to assess these risk and risk factors more accurately through a population-based study to provide basic data for prevention strategies. METHODS: This open retrospective cohort included data of 419,101 women with gestational diabetes and matched 1,228,802 control women who delivered between 2004 and 2016 from the South Korea National Health Information Database of the National Health Insurance Service. Following 14 (median 5.9) years of follow-up, the incidence and hazard ratio (HR) of postpartum T2DM were evaluated using Kaplan-Meier curves and Cox proportional regression models. RESULTS: The incidence and HR of postpartum T2DM in women with gestational diabetes (compared to women without gestational diabetes) after the 14-year follow-up was 21.3% and 2.78 (95% confidence interval [CI], 2.74 to 2.82), respectively. Comorbid obesity (body mass index [BMI] ≥25 kg/m2) increased postpartum T2DM risk 7.59 times (95% CI, 7.33 to 7.86). Significant risk factors for postpartum T2DM were fasting glucose level, BMI, age, family history of diabetes, hypertension, and insulin use during pregnancy. CONCLUSION: This population-based study showed higher postpartum T2DM risk in women with gestational diabetes than in those without, which was further increased by comorbid obesity. BMI and fasting glucose level were important postpartum risk factors. The management of obesity and glycemic control may be important strategies to prevent the incidence of diabetes after delivery.

Pregnant Women's Labor Progress, Childbirth Outcome, and Childbirth Satisfaction according to the Presence or Absence of Labor Induction.

PURPOSE: To provide accurate information on induced labor and find strategies to enhance women's childbirth satisfaction. METHODS: Participants were pregnant women expected to have normal vaginal delivery. A total of 113 women with induced labor and 61 women with spontaneous labor were surveyed. Data were collected using a questionnaire and electronic medical records. RESULTS: The following variables related to labor progress showed significant differences between the induced labor group and the spontaneous labor group: length of the first stage of labor in primigravidas, use of analgesic, incidence of uterine hyperstimulation, incidence of fetal distress, and medical treatment for the expectant mother. Delivery type and the incidence of postpartum complications showed significant difference between the two groups. Induced labor women's childbirth satisfaction was mainly affected by the process of labor whereas spontaneous labor women's childbirth satisfaction was affected by the outcome of childbirth. CONCLUSION: Medical staff should have accurate information on the risk of induced labor and the benefits of a natural delivery. Moreover, medical staff should provide necessary information and environment for women to participate in the decision-making process.

Development of the Korean Pregnancy Stress Scale.

AIM: This study was conducted in order to develop and evaluate a Pregnancy Stress Scale (PSS). METHODS: The PSS was developed according to Devellis' scale development process. Data that were collected from 388 pregnant women were used to evaluate the validity and reliability of the tool. An item analysis, factor analysis, Pearson's correlation coefficients, and Cronbach's α were used. RESULTS: The PSS comprised seven factors that can be applied to all pregnant women, with one additional factor that is dedicated specifically for working pregnant women, resulting in a total of eight factors with 43 items: physical and psychological changes, coping in daily life, health of the mother and baby, maternal role, family support, healthcare services, social atmosphere, and reconciliation of work life. The criterion validity was supported by the Revised Prenatal Distress Questionnaire and Edinburgh Postnatal Depression Scale. The reliability of the overall scale was adequate. CONCLUSION: This scale would be useful for understanding the complex factors that contribute to pregnant women's stress and also would contribute to the process of developing nursing interventions to reduce pregnancy stress.

Delivery Room Nurses' Experiences of Caring for Stillborn Babies and Their Parents.

PURPOSE: The purpose of the study was to have an in-depth understanding of delivery room nurses'experiences of caring for stillborn babies and their parents. METHODS: After obtaining approval from the Institutional Review Board, data were collected from March 1 to August 30, 2016. A total of six nurses participated in the study. Semi-structured in-depth interviews were conducted and the data subsequently analyzed. RESULTS: Using thematic analysis, six themes were defined and refined: Emotional distress as a result of encountering stillborn babies; Caring for the deceased baby; Concerns for the mother's pain; Consideration for the father; Conflicts between accepting and dismissing parents' requests; and Strong mindset for the stillborn babies and their parents. CONCLUSION: The results showed that the nurses' experiences of caring for stillborn babies and their parents might be a difficult and lonely process. However, it could also be a process of attaining maturity by finding meaning and value in one's work. It would be helpful for the delivery room nurses to share examples of effective communication, train through simulation, and learn useful strategies that each nurse can use.

Health behaviors and risk factors associated with chronic kidney disease in Korean patients with diabetes: the Fourth Korean National Health and Nutritional Examination Survey.

PURPOSE: The purpose of this study was to identify health behavior and risk factors for chronic kidney disease (CKD) in Korean patients with diabetes. METHODS: This study was a secondary analysis of the Fourth Korean National Health and Nutritional Examination Survey (2007-2009). Of the 24,871 participants, 1,239 aged over 19 years with diagnosis of diabetes were included. Stratified and cluster variables in the analysis-plan file for a weighted, complex sample were analyzed. CKD was confirmed by the estimated glomerular filtration rate level of 15.0-59.9 mL/min/1.732 m(2). Odds ratios between the variables and CKD were calculated using logistic regression analysis with adjustment for gender, age, educational background, income, and duration of diagnosis. RESULTS: The results showed that 14.7% of participants with diabetes were accompanied with CKD. The risk of developing CKD in those who made efforts to take proper nutrition but failed was 1.76 times higher than those taking nutrition properly. In those who used to smoke compared to their nonsmoking counterparts, the risk was 2.06 times higher; in those who did not do vigorous exercise compared to those who did, the risk was 2.12 times higher; in those with hypertension than those without, the risk was 2.4 times higher; and in those with anemia compared to those without, the risk was 2.32 times higher. Only 19% of the participants received health education for diabetes, which did not affect the incidence of CKD. CONCLUSION: Since renal functions are affected by lifestyle factors, it is critical for healthcare professionals to provide diabetic patients with health education focused on changing their behavior so that it is conducive to health. It is also necessary to consider that diabetes education should be made more available and provided more effectively to these patients.

[Structural equation modeling on contraception behavior of unmarried men and women in Korea: gender difference].

PURPOSE: The purpose of this study was to test and validate a model to predict contraception behavior in unmarried men and women. METHODS: Data were collected from a questionnaire survey of 180 unmarried men and 186 unmarried women 20 years of age or over who had sexual relationships in the past 6 months. Participants were from Seoul, Kyunggi, Daegu, and Busan and data collection was done from February 19 to April 16, 2013. RESULTS: Model fit indices for the hypotheoretical model fitted to the recommended levels. Out of 15 paths, 11 were statistically significant in both. Predictors of contraception behavior in unmarried men and women were intention to use contraception and self-efficacy for contraception. Exposure to sexual content was directly significant to the intention in men only. Self-efficacy for contraception was affected by perceived threat of pregnancy and gender role attitude. In women, the two predictors were also significant except for the effect of exposure to sexual contents. CONCLUSION: Results indicate that an intervention program which increases self-efficacy in unmarried men and women contributes to effective contraception behavior. In addition, proper sexual education programs using positive aspect of mass media can help develop active participation for contraception behavior.

Factors of Prenatal Depression by Stress-vulnerability and Stress-coping Models.

PURPOSE: This study aimed to identify related factors of prenatal depression by stress-vulnerability and stress-coping models for pregnant women. METHODS: A cross-sectional survey design with a convenience sampling was used. A total of 107 pregnant women who visited a general hospital in a metropolitan city were recruited from August to October, 2013. A structured questionnaire included the Korean version of Beck Depression Inventory II, and the instruments measuring Self-Esteem, Marital Satisfaction, Pregnancy Stress, Stressful Life Events, and Coping. The data were analyzed using descriptive statistics, t-test, Parson's correlation analysis, and stepwise multiple regression. RESULTS: The mean score of prenatal depression was 11.95+/-6.2, then showing 19.6% with mild depression, 15.0% with moderate depression, and 0.9% with severe depression on BDI II scale. Prenatal depression had positive correlation with pregnancy stress (r=.55, p<.01), stressful life events (r=.26, p<.01) and negative correlation with self-esteem (r=-.38, p<.01), marital satisfaction (r=-.40, p<.01), and coping (r=-.21, p<.05). Factors of pregnancy stress, self-esteem, stressful life events, and planned pregnancy explained 38% of the total variance of prenatal depression. CONCLUSION: These findings show that health providers need to assess prenatal depression and to control the influencing factors.

Effects of Body Weight Control Behaviors on Bone Mineral Density in Korean Young Adult Women.

PURPOSE: This study identified the effects of body weight control behaviors on bone mineral density (BMD) in Korean women aged 20 to 39 years. METHODS: A secondary analysis of the 5th Korean National Health and Nutrition Examination Survey was conducted. Asian-Pacific criteria of BMI (Body Mass Index) and BMD were calculated for 1,026 women selected. The effects of body weight control behaviors were assessed using binary multiple logistic regression analysis while controlling for BMI. RESULTS: Osteopenia and osteoporosis rates were 32.8% and 2.0%, respectively. About 69% of women performed weight control behaviors, and a combination of diet/exercise (22.7%) and drug added methods (10.9%) for weight control. Women who performed both diet control and exercise had a lower possibility to have abnormal BMD than those who did not try weight control (OR=0.67, CI=0.45~0.98, p=.039). Further weight control behaviors did not influence abnormal BMD. CONCLUSION: Body weight control should include proper diet and exercise in accordance with each woman's BMI level.

[Depression of married and employed women based on social-role theory].

PURPOSE: This study was based on social-role theory, and purposes were to investigate (1) how depression and health determinants vary with married and employed women, and (2) what factors contribute to depression according to family cycle. METHODS: A stratified convenience sample of 765 married and employed women was recruited during May to August 2010. Study variables of depression, socio-demographic threatening factors, psycho-stimulating factors, and social-role related factors were measured via a structured questionnaire. RESULTS: Prevalence rate for depression was 18.6%, with highest rate (25.4%) from elementary laborers. Greater levels of depression were related to women's occupation, higher life stress, and poorer health; lower social support and vulnerable personality; higher levels of social-role related stress. From multivariate analysis, women with preadolescents were the most vulnerable to depression affected by occupation, life stress, personality, and parenting stress. These factors (except for occupational class) combined with economic status, social support, and housework unfairness were significant for depression in women with adolescents. CONCLUSION: Depression among married and employed women differs by psycho-stimulating and social role relevant factors in addition to occupational class and family life cycle. Female elementary laborers and women with children need to have the highest prioritization for community mental health programs.

Details of Lymphedema, Upper Limb Morbidity, and Self Management in Women after Breast Cancer Treatment.

PURPOSE: To examine the details of lymphedema, upper limb morbidity, and its self management in women after breast cancer treatment. METHODS: Using a cross-sectional survey design, 81 women were recruited from a university hospital. Lymphedema was detected by a nurse as a 2-cm difference between arm circumferences at 6 different points on the arm. Degrees of pain, stiffness, and numbness were scored using a drawing of upper limb on a 0~10 point scale. Aggravating conditions and self-management for lymphedema were also recorded. RESULTS: The mean age of the participants was 52.5 years; the average time since breast surgery was 29.7 months. Histories of modified radical mastectomy (55%) and lymph node dissection (81%) were noted. Lymphedema was found in 59% of women, then pain and stiffness were prevalent most at upper arm while numbness was apparentat fingers, and the symptom distress scores ranged 3.9~6.7. Women experienced aggravated arm swelling after routine housework with greatly varied duration. Self-management was conservative with a wide range of times for the relief of symptoms. CONCLUSION: Lymphedema education for women with breast cancer should be incorporated into the oncologic nursing care system to prevent its occurrence and arm morbidity. Risk reduction guidelines, individually tailored self-care strategies, and self-awareness for early detection need to be refined in clinical nursing practices.

Student Experience and Satisfaction with Clinical Nursing Practice in Women's Health Nursing.

PURPOSE: The purpose of this study was to identify students' experiences of performance and their satisfaction with clinical nursing practice in Women's health nursing. METHODS: Data was collected using questionnaire consisting of 104; 89,; and 82 nursing activities with 12; 10; and 7 domains for delivery floor, obstetric, and gynecologic wards retrospectively. Five hundred ninety nursing students from 10 four year and one three year colleges, were recruited and selected for data collection. RESULTS: Site specific core nursing activities among top 15 items of performed experience were: interpreting fetal monitoring; massage for pain reduction; breathing technique; perineal pad change; non stress test; manual check for uterine contraction; and position change for the delivery floor. Experiences of clinical nursing practice for the obstetric ward and the gynecologic ward were identified and ranked as well. Observation of delivery, measurement & test during labor and observation of anesthesia and operation were the highest ranked activity domains of satisfaction for delivery floor, obstetric and gynecologic wards retrospectively. CONCLUSION: Discussions are needed to standardize curriculum for clinical practice in women's health nursing initiated at the level of Korean Society of Womens' Health Nursing by reflecting this result. Strategic approaches are emphasized in order to enhance a collaboration between clinical fields and colleges.

Contraception Behavior and Related Factors in Unmarried Female and Male.

PURPOSE: This study aimed to identify differences in contraception behavior and related factors between unmarried female and male. METHODS: A cross-sectional survey design with a convenient sampling was used. From Seoul, 107 women and 96 men were recruited. A structured questionnaire was self-administered from July 14, 2008 to September 2, 2008. RESULTS: The average ages of women and men were 26.9 and 27.8 years old, respectively. Fifty-six percent of women and 85.4% of men have experienced sexual intercourse. There were no differences between female and male in attitude toward contraception, subjective norm, and contraception behavior, while female had higher score of self-efficacy for contraception (p=.02) and intention of contraception (p=.02). There was positive correlation with subjective norm (r=.22, p<.05), self-efficacy (r=.53, p<.01) in male and attitude (r=.32, p<.05), self-efficacy (r=49, p<.01) in female. According to the result of multiple regression, the significant factor of contraception behavior was self-efficacy for both female (beta=.49, p=.00) and male (beta=.53, p=.00). CONCLUSION: To improve contraception behavior for unmarried female and male, it is necessary to develop proper sex education program to enhance self-efficacy for contraception. Adjusted education program by this result will contribute to increase sexual health for female and male.

Grandmother's Life Satisfaction and Influencing Factors by Grandparenting.

PURPOSE: The study was to compare the factors of life satisfaction between grandmothers parenting and not parenting their grandchildren. METHODS: A descriptive design with a convenience sampling was used for this study. From communities in S and U city, 85 parenting grandmothers (PG) and 103 non-parenting grandmothers (NPG) were recruited. The PG were those grandmothers who cared for preschooler grandchildren for their daughter or daughter-in-law who was employed. RESULTS: The demographics of the two groups were similar, however the value of grandparenting was significantly higher in the PG than the NPG (t=4.56, p<.001). In the PG, strong and significant correlations were found among the value of grandparenting, health status, quality of relations with adult children, and life satisfaction. However, demographics were more related to health status and life satisfaction in the NPG. The value of grandparenting, health status, and quality of grandmother-adult children relations were found to be significant factors of life satisfaction (F=20.75, p<.001) explaining 42% of the variances. In the NPG, only health status was a significant factor (F=50.66, p<.001) explaining 33% of the variances. CONCLUSION: This study shows that grandmothers' perceptions of grandparenting and family relationships need to be incorporated into the lifestyle in order to support parenting grandmothers' life satisfaction while grandmothers' health is the common concern of elderly women's life satisfaction.

Effects on Nursing Students of Cognition-Behavior Integrated Breast Cancer Prevention Education Using an Interchangeable Nodule Model.

PURPOSE: The study was done to examine the effects of cognition-behavior integrated breast cancer prevention education, in which a breast model with interchangeable nodules was utilized, on the self-competency of nursing students in performing breast cancer education. METHODS: A nonequivalent control group non-synchronized design was used. A traditional lecture intervention was provided for 49 3rd year college of nursing students (control group) while the integrated breast cancer prevention education was given to 47 3rd year students in the same college one year later (experimental group). The integrated breast cancer prevention education was developed by the research team to strengthen the competency of cognitive and behavioral components in education on breast cancer. RESULTS: Effects of the intervention were found to be significant through all study variables: knowledge about breast cancer (t=7.79, p <.001), breast cancer risk awareness (t=2.05, p <.05), self-competency of breast self-exam (t=8.27, p <.001), and intention to teach breast self-exam (t=3.87, p <.001). CONCLUSION: The integrated breast cancer prevention education was useful to improve not only knowledge about breast cancer but competency in performing breast examination for nursing students who acquired technical skills from various simulation nodules. As the program helped the students to be prepared as confident educators, future application of the module is recommended for academic curricula.

[Educational issues and strategies to improve APN education].

PURPOSE: This study was aimed at exploring the current status of graduate programs for an advanced practice nurse(APN) to recommend future directions of APN education. METHODS: A total of 142 students enrolled in seven APN specialty programs, 67 professors who were involved in APN education, and nine nurse administrators participated in the study. Data was collected by questionnaires and focus group interviews. RESULTS: The current definition of APN was found not to be specific enough to represent expected roles of APN in regards to knowledge, attitudes, roles, and skills. Standard curricula employed regardless of the area of APN specialty, lack of qualified clinical practice settings, as well as prepared instructors were found to be problematic. CONCLUSION: The following needs to be addressed: 1. redefining of APN roles, 2. tailoring specialty areas of APN, 3. consolidating educational programs, and 4. ensuring APN role models and faculty. Suggesting a CNS role in Korean APN, areas of APN should be rearranged to clarify their roles and educational programs need to be further developed to meet the expectations and quality of APNs. It is necessary to ensure APN's employment in the health care system by laws and policies to perform advanced nursing roles.