Long-term Care Facility Staff's Experience of Safety Activities: A Qualitative Study.

BACKGROUND: Ensuring the safety and quality of care is paramount in long-term care facilities due to residents' vulnerability. OBJECTIVE: We explored the experiences of long-term care facility staff (eg, registered nurses [RNs], certified nursing assistants [CNAs], care workers, social workers, and physical therapists) in safety activities, aiming to understand their meaning and nature. METHODS: We conducted qualitative focus group interviews with 25 participants, specifically addressing safety issues in long-term care facilities through the use of open-ended questions. We transcribed the data and conducted thematic analysis. RESULTS: Participants engaged in discussions about various challenges, including assisting residents in maintaining physical comfort, managing behavioral and psychological symptoms of dementia, ensuring medication safety, implementing infection control practices, and providing adequate training on fire prevention, evacuation, and response protocols. Themes identified were "physical comfort," "managing dementia symptoms," "drug administration," "infection control," and "fire prevention." CONCLUSIONS: The staff emphasized the safety of residents as their highest priority. Considering the lack of registered nurses in long-term care facilities, ongoing training and supervision are necessary to ensure that other long-term care facility staff can perform safety activities.

Crystalline Porphyrazine-Linked Fused Aromatic Networks with High Proton Conductivity.

Fused aromatic networks (FANs) have been studied in efforts to overcome the low physicochemical stability of metal-organic frameworks (MOFs) and covalent organic frameworks (COFs), while preserving crystallinity. Herein, we describe the synthesis of a highly stable and crystalline FAN (denoted as Pz-FAN) using pyrazine-based building blocks to form porphyrazine (Pz) linkages via an irreversible reaction. Unlike most COFs and FANs, which are synthesized from two different building blocks, the new Pz-FAN is formed using a single building block by self-cyclotetramerization. Controlled and optimized reaction conditions result in a highly crystalline Pz-FAN with physicochemical stability. The newly prepared Pz-FAN displayed a high magnitude (1.16×10-2  S cm-1 ) of proton conductivity compared to other reported FANs and polymers. Finally, the Pz-FAN-based membrane was evaluated for a proton-exchange membrane fuel cell (PEMFC), which showed maximum power and current densities of 192 mW cm-2 and 481 mA cm-2 , respectively.

Human Rights of Persons With Mental Illness After the Korean Mental Health Act Revision: A Qualitative Study.

After the Constitutional Court of Korea ruled that the provision of involuntary admissions was unconstitutional, as it violates personal freedom, the Mental Health and Welfare Act was amended in 2016. The current study explores involuntary admission and discharge experiences, after the law's revision, from a patient-centered perspective and suggests future directions to protect human rights. Data were collected from seven persons with mental illness and three family members through in-depth individual interviews and analyzed using thematic analysis. Persons with mental illness were still not guaranteed full autonomy and the right to receive proper treatment due to lack of mental health resources. The burden on family caregivers was amplified by stricter admission requirements. These results indicate the need for human rights-friendly emergency services, including peer crisis shelters and procedural assistance services. The government should develop community-based mental health services to ensure continuity of care without imposing public responsibility on family members. [Journal of Psychosocial Nursing and Mental Health Services, 60(8), 27-35.].

Abrading bulk metal into single atoms.

Single-atom catalysts have recently attracted considerable attention because of their highly efficient metal utilization and unique properties. Finding a green, facile method to synthesize them is key to their widespread commercialization. Here we show that single-atom catalysts (including iron, cobalt, nickel and copper) can be prepared via a top-down abrasion method, in which the bulk metal is directly atomized onto different supports, such as carbon frameworks, oxides and nitrides. The level of metal loading can be easily tuned by changing the abrasion rate. No synthetic chemicals, solvents or even water were used in the process and no by-products or waste were generated. The underlying reaction mechanism involves the mechanochemical force in situ generating defects on the supports, then trapping and stably sequestering atomized metals.

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.

Tablet PC-based competency evaluation for nursing students in three Asian countries: Cross-sectional comparative study.

AIM: This study evaluated a practical competency evaluation for nursing students in three Asian countries using tablet PC-based tests. The need to evaluate practical competencies in a non-face-to-face manner continues to pose challenges in nursing education. DESIGN: This study presents descriptive comparative research on a tablet PC-based evaluation of practical competencies in three countries. METHODS: tablet PC-based clinical practice competency evaluation was conducted among nursing college students in Korea, Vietnam and Mongolia. In total, 124 students answered 65 questions for practical competency evaluation and items on its usefulness. RESULTS: Students from Korea had the highest score of nursing competencies (41.6 points; n = 59, SD 6.02), followed by those from Vietnam (26.3 points; n = 30, SD 4.97) and Mongolia (18.4 points; n = 35, SD 5.36). Scores for usability showed an inverse relationship with competency scores. Questions incorporating video showed the lowest proportion of low-discrimination items. CONCLUSIONS: This research recognized that using video which provides contextual elements can increase item discrimination. These findings suggest that incorporating video into evaluation items in tablet-PC-based tests is useful for international comparison.

Effects of the Mental Health and Welfare Law revision on schizophrenia patients in Korea: an interrupted time series analysis.

BACKGROUND: High rates of involuntary hospitalization and long lengths of stay have been problematic in Korea. To address these problems, the Mental Health and Welfare Law was revised in 2016, mainly to protect patient rights by managing involuntary admissions. The aim of this study was to evaluate the impact of the revised Mental Health and Welfare Law on deinstitutionalization by using routinely collected data from hospital admissions and continuity of mental health service use after hospital discharge as proxy measures of deinstitutionalization. METHODS: We used monthly-aggregated claims-based data with a principal or secondary diagnosis of schizophrenia from 2012 to 2019, collected by the National Health Insurance Service. Outcome variables included rates of first admission; discharges; re-admissions within 7, 30, and 90 days; outpatient visits after discharge within 7 and 30 days; and continuity of visits, at least once a month for 6 months after discharge. Using interrupted time series analysis, we estimated the change in levels and trends of the rates after revision, controlling for baseline level and trend. RESULTS: There was no significant change in first admission and discharge rates after the revision. Immediately after the revision, however, the rates of re-admission within 7 and 30 days dropped significantly, by 2.24% and 1.99%, respectively. The slopes of the re-admission rate decreased significantly, by 0.10% and 0.14%, respectively. The slopes of the re-admission rate within 90 days decreased (0.001%). The rates of outpatient visits within 7 and 30 days increased by 1.98% and 2.72%, respectively. The rate of continuous care showed an immediate 4.0% increase. CONCLUSIONS: The revision had slight but significant effects on deinstitutionalization, especially decreasing short-term re-admission and increasing immediate outpatient service utilization.

Synthesis of Saddle-Shape Octaaminotetraphenylene Octahydrochloride.

Apart from being experimentally and theoretically interesting, tetraphenylene has potential applications in different fields, including supramolecular chemistry, material science, and asymmetric catalysis. Although a wide range of substituted tetraphenylenes have been reported, octaamine-based tetraphenylene derivatives have not been reported because of their instability. Here, stable octaaminotetraphenylene octahydrochloride is synthesized from the bromination of tetraphenylene to octabromotetraphenylene, which is subsequently aminated into octaiminotetraphenylene. Finally, the imino derivative is deprotected to yield octaaminotetraphenylene octahydrochloride.

Effectiveness of Integrated Education to Reduce Postoperative Nausea, Vomiting, and Dizziness after Abdominal Surgery under General Anesthesia.

This study presents an anticipatory integrated education program for nausea, vomiting, and dizziness prevention (anti-NVD education program) for patients undergoing abdominal surgery under general anesthesia. The anti-NVD education program for nephrectomy patients consisted of the following: the causes of postoperative nausea, vomiting, and dizziness; effective deep breathing and how to use an inspirometer; postoperative nausea and vomiting; effective methods of patient-controlled analgesia; and the stepwise standing up method to prevent dizziness. A study was conducted among 79 adults (experimental group: n = 40, control group: n = 39). The degree of nausea and dizziness was measured using a numerical rating scale (NRS), and vomiting and the frequency of antiemetic use were measured in terms of the number of patients. The experimental group, which received the anti-NVD education, showed remarkably lower levels of nausea (p = 0.013) and dizziness (p < 0.001) than the control group. The frequency of antiemetic use 48 hours after surgery was significantly lower in the experimental group (p = 0.03). This study proved the efficacy of the anti-NVD education program for reducing postoperative nausea and dizziness. This program can be used as a noninvasive nursing intervention to prevent nausea, vomiting, and dizziness among patients undergoing abdominal surgery.

Uncertainty and Nursing Needs of Parents with Pediatric Cancer Patients in Different Treatment Phases: A Cross-Sectional Study.

The survival rate of pediatric cancer has increased to 80%, but long-term treatment is required. During treatment, parents experience uncertainty, which affects parents' quality of life and, even worse, their children's health; however, the variation of that uncertainty remains under-studied. Thus, it is crucial to understand parents' nursing needs in each distinct treatment phase to develop relevant educational content. This study investigated the uncertainty level and nursing needs of parents according to their children's treatment phase. This cross-sectional comparative descriptive study collected survey data from 119 people at a tertiary hospital from December 2017 to April 2018. Nursing needs were ascertained using open-ended questions, and data were analyzed using quantitative content analysis. The uncertainty levels of parents of pediatric cancer patients showed statistically significant differences across treatment phases (F = 8.209, p < 0.001). Parents' uncertainty was higher in the treatment initiation phase (87.77 ± 13.43) and when treatment was ongoing (83.33 ± 15.10) than in the post-treatment phase (75.35 ± 12.82). All three groups had nursing needs regarding infection control, diet, daily activities of living, and prognosis. Parents' uncertainty levels and nursing needs differed across treatment phases, suggesting a need for tailored education programs to provide practical support to parents of pediatric cancer patients in each phase.

Awareness of Doctors' Shared Decision-Making in Life-Sustaining Care Decisions.

Purpose: At the end of life, communication is a key factor for good care. However, in clinical practice, it is difficult to adequately discuss end-of-life care. In order to understand and analyze how decision-making related to life-sustaining treatment (LST) is performed, the shared decision-making (SDM) behaviors of physicians were investigated. Methods: A questionnaire was designed after reviewing the literature on attitudes toward SDM or decision-making related to LST. A final item was added after consulting experts. The survey was completed by internal medicine residents and hematologists/medical oncologists who treat terminal cancer patients. Results: In total, 202 respondents completed the questionnaire, and 88.6% said that the decision to continue or end LST is usually a result of SDM since they believed that sufficient explanation is provided to patients and caregivers, patients and caregivers make their own decisions according to their values, and there is sufficient time for patients and caregivers to make a decision. Expected satisfaction with the decision-making process was the highest for caregivers (57.4%), followed by physicians (49.5%) and patients (41.1%). In total, 38.1% of respondents said that SDM was adequately practiced when making decisions related to LST. The most common reason for inadequate SDM was time pressure (89.6%). Conclusion: Although most physicians answered that they practiced SDM when making decisions regarding LST, satisfactory SDM is rarely practiced in the clinical field. A model for the proper implementation of SDM is needed, and additional studies must be conducted to develop an SDM model in collaboration with other academic organizations.

Vertical two-dimensional layered fused aromatic ladder structure.

Planar two-dimensional (2D) layered materials such as graphene, metal-organic frameworks, and covalent-organic frameworks are attracting enormous interest in the scientific community because of their unique properties and potential applications. One common feature of these materials is that their building blocks (monomers) are flat and lie in planar 2D structures, with interlayer π-π stacking, parallel to the stacking direction. Due to layer-to-layer confinement, their segmental motion is very restricted, which affects their sorption/desorption kinetics when used as sorbent materials. Here, to minimize this confinement, a vertical 2D layered material was designed and synthesized, with a robust fused aromatic ladder (FAL) structure. Because of its unique structural nature, the vertical 2D layered FAL structure has excellent gas uptake performance under both low and high pressures, and also a high iodine (I2) uptake capacity with unusually fast kinetics, the fastest among reported porous organic materials to date.

Maternal, neonatal, and child health systems under rapid urbanization: a qualitative study in a suburban district in Vietnam.

BACKGROUND: Vietnam has been successful in increasing access to maternal, neonatal, and child health (MNCH) services during last decades; however, little is known about whether the primary MNCH service utilization has been properly utilized under the recent rapid urbanization. We aimed to examine current MNCH service utilization patterns at a district level. METHODS: The study was conducted qualitatively in a rural district named Quoc Oai. Women who gave a birth within a year and medical staff at various levels participated through 43 individual in-depth interviews and 3 focus group interviews. RESULTS: Primary MNCH services were underutilized due to a failure to meet increased quality needs. Most of the mothers preferred private clinics for antenatal care and the district hospital for delivery due to the better service quality of these facilities compared to that of the commune health stations (CHSs). Mothers had few sociocultural barriers to acquiring service information or utilizing services based on their improved standard of living. A financial burden for some services, including caesarian section, still existed for uninsured mothers, while their insured counterparts had relatively few difficulties. CONCLUSIONS: For the improved macro-efficiency of MNCH systems, the government needs to rearrange human resources and/or merge some CHSs to achieve economies of scale and align with service volume distribution across the different levels.

Patients help other patients: Qualitative study on a longstanding community cooperative to tackle leprosy in India.

BACKGROUND: Although leprosy is portrayed as a disappearing disease, leprosy affected persons in India are still suffering massively. Even further, nearly 60% of the world's newly detected cases are appearing from India alone. The problem has exacerbated due to the drastic decrease of global funding after India's official declaration of 'elimination', which did not foster the actual pain of patients beyond prevalence. Leprosy patients have hardships in their lives due to disabilities, stigma and poverty; thus, they require sustained, continuous care even after release from treatment. Yet, current interventions mostly have a vertical, short-term approach, not showing much progress in lightening the burden of leprosy. In contrast, Little Flower Hospital Community (LFHC) in India has been remarkably providing holistic care for thousands of leprosy patients for 35 years. However, there has not been any research conducted to uncover the underlying factors of this longstanding leprosy control model. Therefore, this research explores the in-depth contextual attributes of this hospital community that has been able to successfully provide sustainable care for a long time even without excessive external funds. METHODS AND FINDINGS: This qualitative research used a grounded theory approach, involving 28 in-depth interviews of 11 patients, 13 workers, and 4 board members from the hospital. The interview data were inductively analyzed to examine the contextual factors of the hospital's sustainability. Open coding, axial coding and selective coding were conducted, and Glaser's Six C's model was used to create a theoretical model of the sustainability of LFHC. The fundamental cause of the sustainability was the leprosy patients' strong craving for life with dignity, despite the isolation from the society. The desire resulted in a bottom-up formation of a 'consumer-provider cooperative', where patients mutually support each other with basic treatment learned from experience. The profits earned from the patients' occupational efforts such as dairy farming, cover the costs needed to manage the hospital community, which contributes to economical sustainability. Social sustainability was established through the holistic care including psychosocial, educational, medical, and residential support. The wholesome care socially rehabilitated the patients to be included in the society with satisfaction, social justice and social cohesion. The main limitation of this study is that this study cannot be generalized due to the nature of Grounded Theory based study. CONCLUSIONS: This study investigated the determinants that made LFHC sustainable, and the findings suggested the importance of forming a cooperative community and implementing social rehabilitation for sustainable leprosy control. More exploration on transferring this model to other leprosy colonies will have great impact in maintaining sustainable care for leprosy patients. Furthermore, this research may highlight the importance of sustainable development in policies targeting neglected tropical diseases beyond leprosy as well.

Two-dimensional amine and hydroxy functionalized fused aromatic covalent organic framework.

Ordered two-dimensional covalent organic frameworks (COFs) have generally been synthesized using reversible reactions. It has been difficult to synthesize a similar degree of ordered COFs using irreversible reactions. Developing COFs with a fused aromatic ring system via an irreversible reaction is highly desirable but has remained a significant challenge. Here we demonstrate a COF that can be synthesized from organic building blocks via irreversible condensation (aromatization). The as-synthesized robust fused aromatic COF (F-COF) exhibits high crystallinity. Its lattice structure is characterized by scanning tunneling microscopy and X-ray diffraction pattern. Because of its fused aromatic ring system, the F-COF structure possesses high physiochemical stability, due to the absence of hydrolysable weak covalent bonds.

Corrigendum to "Health Status and the Demand for Healthcare among the Elderly in the Rural Quoc-Oai District of Hanoi in Vietnam".

[This corrects the article DOI: 10.1155/2017/4830968.].

The roles of, activities of, and competencies for, community nursing services in rural Vietnam: Implications for policy decisions.

Community health workforce plays a vital role in providing primary health care services as per the needs of residents; however, few studies have examined how nurses work within commune health centers (CHCs). Using qualitative methods including interviews and focus group discussions with key stakeholders, this study explores the roles, activities, and competencies required of community nursing services in rural districts within Vietnam. Two primary roles were identified: CHC nursing and family nursing. For the latter, in addition to providing people with general health care and health communication, they were expected to also deliver psychological care. CHC nursing fulfilled more roles and required four specific competencies: clinical care, communication, management, and planning/coordination activities. Despite these various roles serving people within a community, few ongoing efforts at either the local or national level are aimed at supporting these nurses. The study highlights the need for policy decisions via either developing a new job position policy or adapting the existing policy by integrating new roles into the existing positions of CHC nurses in Vietnam.

Direct Synthesis of a Covalent Triazine-Based Framework from Aromatic Amides.

There have been extensive efforts to synthesize crystalline covalent triazine-based frameworks (CTFs) for practical applications and to realize their potential. The phosphorus pentoxide (P2 O5 )-catalyzed direct condensation of aromatic amide instead of aromatic nitrile to form triazine rings. P2 O5 -catalyzed condensation was applied on terephthalamide to construct a covalent triazine-based framework (pCTF-1). This approach yielded highly crystalline pCTF-1 with high specific surface area (2034.1 m2 g-1 ). At low pressure, the pCTF-1 showed high CO2 (21.9 wt % at 273 K) and H2 (1.75 wt % at 77 K) uptake capacities. The direct formation of a triazine-based COF was also confirmed by model reactions, with the P2 O5 -catalyzed condensation reaction of both benzamide and benzonitrile to form 1,3,5-triphenyl-2,4,6-triazine in high yield.

Wealth gradient-based divergence in the prevalence of underweight among women by marital status in Quoc Oai district, Vietnam.

BACKGROUND: The prevalence of underweight is high among women in Asian countries, despite nutritional changes in the region. Previous studies have demonstrated independent associations between female body weight, marital status and economic status. However, few studies have investigated possible interaction between marital and economic status in relation to Asian women's body weight. OBJECTIVE: This study aimed to test associations between household wealth, marital status and underweight among women living in the Quoc Oai district of Vietnam and to identify wealth-marital status interaction in relation to body weight in these women. METHODS: Data from 1087 women aged 19-60 years were collected via a baseline community survey conducted in the Quoc Oai district of Hanoi, Vietnam, in 2016. Underweight was defined using an Asian-specific body mass index cut-off (<18.5 kg/m2). Marital status was dichotomized into 'never married' and 'ever married.' Economic status was measured using household wealth index quintiles. Multivariable logistic regressions tested association between wealth and underweight after adjusting for marital status and other confounders. An interaction term (wealth index*marital status) was fitted to determine whether the association between wealth and body weight is modified by marital status. RESULTS: Our results show that underweight was independently associated with a wealth status (odds ratio [OR]: 0.88, 95% confidence interval [CI]: 0.79-0.98, p = 0.026) and ever-married status (OR: 0.50, 95% CI: 0.34-0.75, p = 0.002). A significant interaction effect (OR: 0.67, 95% CI: 0.50-0.90, p = 0.010) indicated that wealthy married women were less likely to be underweight, whereas wealthy never-married women were more likely to be underweight. CONCLUSIONS: Our results suggest that the interaction between wealth and marital status has divergent effects on underweight among Asian women. Interventions to reduce underweight among Asian women should simultaneously consider economic and marital status.

Health Status and the Demand for Healthcare among the Elderly in the Rural Quoc-Oai District of Hanoi in Vietnam.

BACKGROUND: Vietnam is experiencing an unprecedented demographic transition. Its proportion of elderly people is growing rapidly. OBJECTIVE: This study explored the health status and health-related quality of life (HRQoL) of rural elderly Vietnamese and assessed their needs for healthcare services. DESIGN: This study used a survey with stratified proportion sampling and quota assignment. In 2016, data was collected from 713 people in the rural Quoc-Oai district of Hanoi aged 60 or older. RESULTS: The mean age of the respondents was 70.9. Both self-rated health status and functional status decreased with age. Women reported more functional limitations than men. Musculoskeletal disorders were the most frequently reported chronic diseases, followed by hypertension, gastrointestinal diseases, and cardiovascular diseases. Age, self-rated health status, BMIs, and the number of noncommunicable diseases (NCDs) were found to be significant determinants of HRQoL, after controlling for socioeconomic effects. More than half the respondents requested more healthcare information, particularly on disease management. CONCLUSIONS: Vietnam's healthcare system is being challenged to make health services easily accessible and meet the growing needs for chronic illness management, risk reduction, promoting healthy lifestyles, and improving the aging population's quality of life.