Correlates of Hepatitis B Virus-related Stigmatization Experienced by Asians: A Scoping Review of Literature.

OBJECTIVE: Although remarkable progress in the pharmacological components of the prevention and treatment of hepatitis B virus (HBV) and liver cancer has been achieved, HBV-related stigma is recognized as a major barrier to HBV management. The purpose of this Revised Social Network Model (rSNM)-guided review was to examine the existing research literature about HBV-related stigma among Asians and Asian immigrants residing in other countries. METHODS: A scoping review of literature was conducted to determine the depth and breadth of literature. Totally, 21 publications were identified. The review findings were linked with the concepts of rSNM to demonstrate how individual factors and sociocultural contexts shape and affect the experience of HBV-related stigma. RESULTS: Most studies were quantitative cross-sectional surveys or qualitative methods research that had been conducted among Chinese in China and in the USA. The three concepts in rSNM that have been identified as important to stigma experience are individual factors, sociocultural factors, and health behaviors. The major factors of most studies were on knowledge and attitudes toward HBV; only three studies focused on stigma as the primary purpose of the research. Few studies focused on the measurement of stigma, conceptual aspects of stigma, or interventions to alleviate the experience of being stigmatized. CONCLUSIONS: The scoping review revealed the existing depth and breadth of literature about HBV-related stigma. Gaps in the literature include lack of research address group-specific HBV-related stigma instruments and linkages between stigma and stigma-related factors.

Factors influencing the confidence in core clinical skills among hospital nurses.

The purpose of this study was to examine the confidence to perform 20 clinical skills and identify factors influencing the confidence of hospital nurses. A descriptive, cross-sectional study was conducted with 550 hospital nurses at four hospitals in B city, Korea. The confidence to perform, frequency of performance and educational needs on 20 clinical skills identified by Korean Accreditation Board of Nursing were measured with a self-reported questionnaire. Data were analysed by SPSS 19.0 (IBM Corporation, Armonk, New York, USA). Participants were 27 years old on average, and 49.5% had less than 3 years of total working experience. The most confident skill was measuring vital signs, whereas the least confident skill was using defibrillator. In results of stepwise regression, confidence to perform was associated with educational needs, total working experience, frequency of performance and position. It is necessary to give opportunities to practice clinical skills at both schools and clinics for producing well-prepared nurses.

Asian flushing: genetic and sociocultural factors of alcoholism among East asians.

Alcohol use can lead to a cascade of problems such as increased chances of risky behavior and negative health consequences, including alcoholic liver disease and upper gastric and liver cancer. Ethanol is metabolized mainly by 2 major enzymes: alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase (ALDH). Genetic variations of genes encoding the 2 enzymes are very common among East Asians but relatively rare for most other populations. Facial flushing and other physical discomforts after alcohol drinking triggered by accumulation of acetaldehyde through defective genes for ADH and ALDH have been reported. Approximately 40% of East Asians (Chinese, Japanese, and Korean) show facial flushing after drinking alcohol, known as "Asian flush," which is characterized by adverse reactions on alcohol drinking in individuals possessing the fasting metabolizing alleles for ADH, ADH1B*2, and ADH1C*1, and the null allele for ALDH and ALDH2*2. Alcoholism is determined not only by the genetic deficiency but also by behaviors that involve complex interactions between genetic and sociocultural factors. The purpose of this article was to provide nurses with the most current information about genetic and sociocultural influences on alcoholism and alcohol-related health problems specifically for East Asians and implications of this knowledge to nursing practice. The physiological phenomenon of genes and genetics in relation to alcohol metabolism in this special population is emphasized.

Which liver enzymes are better indicators of metabolic syndrome in adolescents: the Fifth Korea National Health and Nutrition Examination Survey, 2010.

BACKGROUND: This study aimed to examine the relationships of liver enzyme levels with metabolic syndrome in adolescents. METHODS: A total of 808 adolescents (430 males and 378 females, aged 10-19 years) participated in the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1) in 2010, the relationships between liver enzymes [aspartate aminotransferase (AST), alanine aminotransferase (ALT), ratio of AST to ALT (AST/ALT), and γ-glutamyltransferase (GGT)] and metabolic syndrome defined by the International Diabetes Federation criteria were assessed using logistic regression and receiver operating characteristic (ROC) curve analyses. RESULTS: After adjusting for age, higher ALT and GGT levels and a lower AST/ALT level were associated with clustering of metabolic syndrome components, whereas AST level was not associated with it in both sexes. The strength of association between the liver enzymes and clustering of metabolic syndrome components was higher in females than in males. In the non-overweight group, higher AST, ALT, and GGT levels and a lower AST/ALT level were associated with clustering of metabolic syndrome components, whereas none of the liver enzymes was associated with metabolic syndrome in the overweight group. The area under the ROC curve (AUC) of AST to determine metabolic syndrome was not significant and was significantly lower than AUCs of ALT, AST/ALT, and GGT in both sexes. The cutoff values of ALT, AST/ALT, and GGT to determine metabolic syndrome were higher in males than in females. CONCLUSIONS: ALT, AST/ALT, and GGT were found to be associated with clustering of metabolic syndrome components, and the relationships appear to be sex- and weight group-specific.

Nursing students' experiences with facilitator in problem-based learning class.

PURPOSE: Problem-based learning (PBL) is now extensively utilized within contemporary nursing education. This study was done to explore the nursing students' experiences with facilitators in PBL classes as they transitioned from the first package to the fourth package during the entire sophomore year. METHODS: Twelve nursing students who had taken the course were interviewed after PBL classes. Data were analyzed using dimensional and comparative analysis based on Strauss and Corbin's grounded theory. RESULTS: Findings were organized into phases of participants' experiences with facilitators during PBL classes. They faced interpersonal relationship challenges with facilitators as they moved through the three phases of the continuum: feeling uneasy, overcoming the uneasiness, and valuing the help of the facilitator. In the beginning, uneasiness resulted from proximity to the facilitator. However, seven strategies were derived to respond to the uneasiness during the continuum: (a) searching for information about the facilitator, (b) making efforts to build a positive impression with the facilitator, (c) wanting facilitation, (d) weighing own experiences with facilitator against others' experiences, (e) following facilitator's guidance, (f) reflecting on facilitation experience, and (g) retaining facilitator's remarks. CONCLUSION: Participants overcame the uneasiness and accepted the facilitator as an advisor. These results are significant in providing optimal facilitation for students in PBL classes because they are based on the PBL participants' perspectives of facilitation. Further studies related to facilitators' experiences in the PBL are recommended.

[Patterns of health behavior for weight loss among adults using obesity clinics].

PURPOSE: This ethnography was done to explore patterns of weight management behavior among adults using obesity clinics. METHODS: The participants were 12 adults who were overweight or obese and 2 family members. Data were collected from iterative fieldwork in the obesity clinics of two hospitals. Data were analyzed using text analysis and taxonomic methods. RESULTS: Weight management behaviors among participants varied according to the recognition of the body and motivation for weight control, Participants' behavior was discussed in the socio-cultural context of obesity. Patterns of weight management behavior among participants were categorized by focus: strategic self-oriented type including managements for the body as a social asset and for health, selective neglect type, and passive group value-oriented type including type dependent on others and managements for beauty. CONCLUSION: Participants' weight management behavior was guided by folk concepts of body and health. and constructed within the socio-cultural context. It is necessary for health care providers to understand physical and psychological problems arising from the repeated trials, excessive control of weight, and Western cultural discourse on beauty ideals among adults who are overweight or obese. Therefore, interventions should be tailored to address individual and community needs.

Correlates of hepatitis B virus health-related behaviors of Korean Americans: a situation-specific nursing theory.

PURPOSE: The purpose of this article is to explain the evolution of a situation-specific theory developed to enhance understanding of health-related behaviors of Korean Americans (KAs) who have or are at risk for a chronic hepatitis B virus (HBV) infection. ORGANIZING CONSTRUCT: The situation-specific theory evolved from an integration of the Network Episode Model, studies of health-related behaviors of people with HBV infection, and our studies of and practice experiences with Asian American individuals with HBV infection. FINDINGS: The major concepts of the theory are sociocultural context, social network, individual-level factors, illness experience, and health-related behaviors. CONCLUSIONS: The major propositions of the theory are that sociocultural context, social network, and individual-level factors influence the illness experience, and that sociocultural context, social network, individual-level factors, and the illness experience influence health-related behaviors of KAs who have or are at risk for HBV infection. CLINICAL RELEVANCE: This situation-specific theory represents a translation of abstract concepts into clinical reality. The theory is an explanation of correlates of health-related HBV behaviors of KAs. The next step is to develop and test the effectiveness of a nursing intervention designed to promote behaviors that will enhance the health of KAs who have or are at risk for HBV infection, and that takes into account sociocultural context, social network, individual-level factors, and illness experience.

[Development and evaluation of a program to promote self management in patients with chronic hepatitis B].

PURPOSE: The purpose of this study was to identify the effects of the program to promote self management for patients with chronic hepatitis B. METHODS: The research was a quasi-experimental design using a non-equivalent control group pre-post test. The participants were 61 patients, 29 in the experimental group and 32 in the control group. A pretest and 2 posttests were conducted to measure main variables. For the experimental group, the self-management program, consisting of counseling-centered activities in small groups, was given for 6 weeks. Data were analyzed using χ², t-test, and repeated measures ANOVA with PASW statistics program. RESULTS: There were statistically significant increases in knowledge, self-efficacy, active ways of coping, and self-management compliance but not in passive ways of coping in the experimental group compared to the control group over two different times. CONCLUSION: The results of this study indicate that the self-management program is effective in increasing knowledge, self-efficacy, active ways of coping, and self-management compliance among patients with chronic hepatitis B. Therefore, it can be usefully utilized in the field of nursing for patients with chronic disease as a nursing intervention for people with chronic hepatitis B.

[Adaptation experience to family of immigrant women in multicultural families].

PURPOSE: This study was to explore adaptation experience to family among women who immigrated for marriage. Specific aims were to identify problems immigrant women face as family members and how they interact with other family members. METHODS: Grounded theory methodology was utilized. Data were collected from iterative fieldwork with individual in-depth interviews from 6 immigrant women as key informants, and 2 of their husbands and 2 of their mothers-in-law as general informants. RESULTS: Through constant comparative analysis, a core category emerged as "tearing down the wall in communicating". Causal conditions were feeling frustrated in one's expectations, differences in language and life style, differences in recognition, and perceptions of discrimination and prejudice. Strategies were learning the Korean language, learning Korean culture, managing stress, mediating differences between family members, and introspecting. Intervening factors were support systems, burdens of child-rearing, and the condition of one's health. Consequences were rooting oneself in one's family and accepting one's life as it is. CONCLUSION: Results of the study indicate that there is a need for nurses to understand differences in communication with family members among immigrant women and to provide information and emotional support to improve the adaptation of these women to their Korean families.

Recognition and management of HBV infection in a social context.

Chronic viral hepatitis B and C infection is three to five times more frequent than HIV in the USA, and chronically infected people are at risk for long-term sequelae including cirrhosis, liver decomposition, and hepatocellular carcinoma (Institute of Medicine, 2010). Socio-cultural factors are central to the way an individual constructs hepatitis B virus (HBV) infection, perceives it as serious health problem, and moves on to appropriate health behavior (Lee et al., J Canc Educ 25:337-342, 2010; Kim, J Health Care Poor Underserved 5:170-182, 2004; Lee et al., Asian Nurs Res 1:1-11, 2007; Wu et al, Asian Pac J Cancer Prev 8(1):127-234, 2007; Yang et al., J Korean Academy Nurs 40:662-675, 2010). The purpose of this study was to seek "real world" data about factors that influence the recognition and management of HBV infection in Korean Americans' socio-cultural contexts. The descriptive qualitative study used an interview informed by ethnography to collect data and was guided by the Network-Episode Model. (Pescosolido, Adv Med Sociol 2:161-184, 1991; Pescosolido, AJS 97:1096-1138, 1992; Pescosolido, Res Sociol Health Care 13A:171-197, 1996). The sample comprised 12 HBV patients and nine key informants. Six factors that influenced the management of HBV infection emerged from the interviews: recognition of disease within a social context, unrecognized disease in a hidden health system, the socio-cultural meaning of disease, lay construction of the cause of disease, misunderstandings and cultural learning styles, and personal and environmental barriers to health care. Each theme was associated with Korean American (KA) social contexts, participants' experiences, and the beliefs they held about the disease. The findings explored that the family network is "genetic code" for social networking among KAs and the network of patients was not geographically bound. Health management behaviors are mediated by an array of types and levels of social and personal networks, and this raises questions about current health education, management of HBV, and prevention of liver cancer.

Alternative view of health behavior: the experience of older Korean women.

In this study we explored the perspectives of older Korean women on the principles and meanings of health behavior. Participants were 12 women age 65 and older, with no serious illnesses requiring hospitalization, who were living independently. We used an interpretative phenomenological approach for data collection and analysis. Seven themes emerged: (a) eating well in accordance with one's physical requirements; (b) maintaining one's inherited health; (c) controlling one's illness properly; (d) maintaining good relationships with close relatives and friends; (e) being modest and free from greed; (f) staying in harmony with nature; and (g) regaining energy and vitality. These experiences were mainly based on the traditional Korean concept of health promotion, "food is medicine," rather than on Western concepts of health promotion. In providing optimal geriatric nursing care for Korean older women, the results will be significant because they are based on older women's traditional Korean perspectives of health promotion rather than existing perspectives of Western medicine.

[The meaning of illness among Korean Americans with chronic hepatitis B].

PURPOSE: This ethnography was done to explore the meaning of illness in Korean Americans with chronic hepatitis B. METHODS: The participants were 6 patients with chronic hepatitis B and 6 general informants who could provide relevant data. Data were collected from iterative fieldwork with ethnographic interviews within Korean communities in two cities in the United States. Data were analyzed using causal chain analysis developed by Wolcott. RESULTS: The analyses revealed three meanings for the illness: hidden disease, intentionally hidden disease, and inevitably hidden disease. The contexts of meaning of illness included characteristics of the illness, social stigma, structure of health care system and communication patterns and discourse between health care providers and clients. CONCLUSION: The meaning of illness was based on folk illness concepts and constructed in the sociocultural context. Folk etiology, pathology and interpretation of one's symptoms were factors influencing illness behavior. These findings could be a cornerstone for culture specific care for Korean Americans with chronic hepatitis B.

Type 2 diabetes in urban and rural districts in Korea: factors associated with prevalence difference.

The purpose of this study was to examine the urban-rural differences in the prevalence and associated factors with type 2 diabetes mellitus (T2DM) in Korean adults. A total of 1,060 adults >30 yr of age from urban (189 males and 331 females) and rural districts (219 males and 321 females) were recruited. Anthropometric measures, blood pressure, lipid profiles, and fasting and 2-hr after 75-g oral glucose load blood glucose were obtained. The crude- and age-standardized prevalence of T2DM was 15.4% and 14.5%, and 11.7% and 8.6% in urban and rural districts, respectively. Diabetic subjects were older and obese, and had a higher triglyceride level, and systolic blood pressure compared to non-diabetes in both population. Multivariate regression analysis revealed that older age, high triglyceride levels, central obesity, and hypertension were significantly associated with T2DM in both areas. Low monthly incomes were significantly associated with T2DM in urban population, while a family history of T2DM was significantly associated with T2DM in rural area. T2DM is more prevalent in urban than in rural population, and low economic status or genetic factor is differently associated with T2DM in both population, respectively.

Management of hepatitis B virus infection.

An estimated 2 million people are living with chronic hepatitis B virus (CHBV) in the United States and are at risk for long-term consequences such as cirrhosis, liver decompensation, and hepatocellular carcinoma. Less than 10 years ago, there was no treatment of CHBV infection, but now, new drugs have recently been approved and there is considerable new knowledge about the treatment of CHBV infection. Recently, consensus guidelines for the management of hepatitis B virus infection have been released by the National Institutes of Health and the American Medical Association, addressing the selection of patients and drugs for treatments. Determining what constitutes best practices to manage patients with CHBV is challenging and requires nurses and nurse practitioners to acquire and maintain up-to-date knowledge to understand recently approved drugs and disease management. Nurses and nurse practitioners should know how to identify patients who need treatment and how to educate, counsel, and monitor treatment adherence and side effects; these skills are crucially important. The goal of this article is to provide nurses with the most current consensus guidelines for the management of CHBV infection and their application in nursing practice to optimize treatment to enhance patient outcomes.

Complexity and uncertainty of living with an invisible virus of hepatitis B in Korea.

The objective of this study was to explore infected Koreans' perceptions, knowledge, and experiences of living with a hepatitis B virus (HBV)-positive diagnosis. The qualitative, descriptive study with a purposive sampling method was utilized. Participants were recruited from hepatology outpatient clinics at an urban Korean university hospital. The findings of this study illustrate the complexity and uncertainty of living with an invisible virus once that one's HBV positive status is known. The themes highlight misunderstanding, confusion, uncertainty, and various perceptions of health management with which the patients have been living. Education of both the general public and people with HBV infection is necessary to reduce HBV infection by preventing transmission of the virus and protecting the livers of infected patients from further damage.

[The effects of hand acupuncture therapy on pain, ROM, ADL and depression among elders with low back pain and knee joint pain].

PURPOSE: The purpose of this study was to identify the effects of hand acupuncture therapy on pain, ROM, ADL, and depression among older people with low back pain and knee joint pain. METHODS: The research was a quasi-experimental design using a non-equivalent control group pre-post test. The participants were 40 patients, 18 in the experimental group and 22 in the control group. A pretest and 2 posttest were conducted to measure the main variables. For the experimental group, hand acupuncture therapy, consisting of hand acupuncture and press-pellets based on corresponding points, was given. RESULTS: There were statistically significant differences in pain, ROM in knee joint, and ADL in the experimental group but not in depression compared to the control group over two different times. CONCLUSION: The hand acupuncture therapy was effective for low back pain, knee joint pain, ROM in knee joint and ADL among the elders in this study. Therefore, the hand acupuncture therapy can be utilized in the field of geriatric nursing as a nursing intervention for older people with low back pain and knee joint pain.

[Qualitative research investigating patterns of health care behavior among Korean patients with chronic hepatitis B].

PURPOSE: This ethnograpy was done to explore patterns of health care behavior in patients with chronic health problems. METHODS: The participants were 15 patients with chronic hepatitis B and 2 family members. Among the patients 4 had progressed to liver cirrhosis and liver cancer. Data were collected from iterative fieldwork in a department of internal medicine of I hospital. Data were analyzed using text analysis and taxonomic methods. RESULTS: Illness and disease, relationship between health care givers and clients, and communication patterns between health professions and clients were discussed as the context of health care behavior. Health care behavior of the participants was categorized by its focus: every day work centered, body centered, organ centered, and pathology centered. CONCLUSION: Participants' health care behavior was guided by folk health concept and constructed in the sociocultural context. Folk etiology, pathology, and interpretation of one's symptoms were influencing factors in illness behavior. These findings must be a cornerstone of culture specific care for the chronic diseases.

[The actual experiences of the living world among cancer patients].

PURPOSE: The purpose of this study was to understand the meanings and nature of living in the world among cancer patients. The present study adopted a hermeneutic phenomenological method which was developed by van Manen. METHOD: The participants for this study were 5 men and 6 women, who were over the age of 20 with admission or a follow up visit in the medical or surgical department. Data were collected by using in-depth interviews and observations from February to September, 2007. The contents of the interviews were tape-recorded with the consent of the subject. RESULT: The essential themes that fit into the context of the 4 existential grounds of body, time, space and other people were: a body that cannot be restored, a body that endures and lives, waiting in uncertainty, a valued calculation for the living day, being in a world of invisible power, reestablishing relationships, and reflection on his or her life. CONCLUSION: These findings revealed that living in the world is affected to varying degrees by the cancer. It is important for nurses to identify and take care of disabilities and to support the reorientation in the disintegrated life situation. The result of this study can give nurses some insight into these experiences and help promote empathetic care.

[Accuracy of references in eight nursing journals in Korea].

PURPOSE: This study was to investigate the reference accuracy in major nursing journals in Korea. METHODS: The references in articles from eight nursing journals from 2006 were compared with PubMed for authors, year, title, journal, volume, and page accuracy. Four hundred sixty-six references were reviewed. Errors were classified as major or minor and categorized by bibliographic headings (author, title, journal, year, volume and page). RESULTS: Of the 466 references, 223(47.9%) had citation errors. The reference error rates ranged from 28.6% to 58.7%. Most errors occurred in the author element (37.9%), followed by title (20.9%), journal (19.0%), page (13.9%), volume (5.9%), and year (2.4%). CONCLUSION: This study identified a considerable error rate in the references of nursing journals. Inaccuracy of references is a reflection on scholarly work of authors and journals. Authors and Editorial committees are responsible for the accuracy of references.

[Analysis of research papers published in the Journal of Korean Academy of Nursing].

PURPOSE: This study was to determine the current trend of nursing research as exploring both quantitative and qualitative methodologies, and to provide the explicit direction to improve the quality of published papers. METHODS: Total of 366 articles published between 2004 and 2006 was reviewed using the criteria of analysis. RESULTS: There was more number of quantitative studies than qualitative studies. More studies were conducted with subjects who had health problems, and studies that targeted women and elderly population have been significantly increased. In quantitative methodology, utilization of experimental and quasi-experimental designs has been increased, however descriptive study was dominant as yet. In qualitative methodology, studies using grounded theory and phenomenology were frequently published. It was noted that theoretical framework and rational for sample size were rarely presented in quantitative study. Philosophical position and the process of preparation for study, which guided the research, were not clearly described in qualitative study. CONCLUSION: The findings of this review suggest that published studies have been improved and diversified, however, detailed and clear evaluation tool that assesses study process and method should be developed as a way to further improve the quality of published papers.