Current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination: an expert Delphi survey among dental hygienists.

PURPOSE: This study aimed to investigate current issues and areas for improvement in the Korean Dental Hygienist National Licensing Examination (KDHNLE) through an expert Delphi survey. METHODS: A Delphi survey was conducted from May through August 2016 in Korea. This Delphi survey included 20 persons representing the field of dental hygiene (7 groups from various dental hygiene-related organizations). The Delphi survey was administered through e-mail as 3 rounds of questionnaire surveys regarding the issues facing the KDHNLE and potential solutions to those challenges. The primary Delphi survey was an open questionnaire. In each round, subjects' responses were categorized according to the detailed themes of their responses. The minimum value of the content validity ratio of the survey results was determined by the number of panels participating in the Delphi survey. RESULTS: Issues facing the KDHNLE were identified from the results of the Delphi survey. The following 4 items had an average importance score of 4.0 or higher and were considered as important by over 85% of the panels: the failure of the practical test to reflect actual clinical settings, the focus of the practical test on dental scaling, the gap between the items evaluated on the national examination and actual practical work, and insufficiency in strengthening the expertise of licensed dental hygienists. The following items were suggested for improvement: more rigorous rater training, adjustment of the difficulty of the licensing examination, the introduction of a specialized dental hygienist system, and more rigorous refresher training for licensed dental hygienists. CONCLUSION: Based on the above results, the KDHNLE should be improved according to the core competencies of dental hygienists, including on-site clinical practice experience.

Subject-Object Asymmetry in the Second Language Acquisition of English Relatives and Embedded Wh-Questions.

This study examined subject-object asymmetry and developmental sequence in the second language (L2) acquisition of three types of wh-extraction, i.e., English headed relatives, headless relatives, and embedded wh-questions. Sixty-four L1 Korean learners of English completed an elicited imitation task and a grammaticality judgment task. The learners demonstrated a subject advantage in the headed RCs and headless RCs, but an object advantage in the embedded wh-questions, which suggests that they treat embedded wh-questions differently from headed relatives and headless relatives despite the similarities in surface forms. The learners further demonstrated the order of developing headless RCs followed by embedded wh-questions, and subsequently headed RCs, which supports the primacy of headless relatives as a simple nominal in L2 development.

Menstrual cyclic change of metastin/GPR54 in endometrium.

Metastin/kisspeptin is encoded by KISS1 and functions as an endogenous ligand of GPR54. Interaction of metastin with GPR54 suppresses metastasis and also regulates release of gonadotropin-releasing hormone, which promotes secretion of estradiol (E2) and progesterone (P4). We have previously demonstrated epigenetic regulation of GPR54 in endometrial cancer and the potent role of metastin peptides in inhibiting metastasis in endometrial cancer. However, little is known about how the metastin-GPR54 axis is regulated in the endometrium, the precursor tissue of endometrial cancer. Endometrial stromal cells (ESCs) and endometrial glandular cells (EGCs) within the endometrium show morphological changes when exposed to E2 and P4. In this study, we show that metastin expression is induced in ESCs through decidualization, but is repressed in glandular components of atypical endometrial hyperplasia (AEH) and endometrial cancer relative to EGCs. The promoter of GPR54 is unmethylated in normal endometrium and in AEH. These results indicate metastin may function in decidualized endometrium to prepare for adequate placentation but this autocrine secretion of metastin is deregulated during oncogenesis to enable tumor cells to spread.

STAT1 drives tumor progression in serous papillary endometrial cancer.

Recent studies of the interferon-induced transcription factor STAT1 have associated its dysregulation with poor prognosis in some cancers, but its mechanistic contributions are not well defined. In this study, we report that the STAT1 pathway is constitutively upregulated in type II endometrial cancers. STAT1 pathway alteration was especially prominent in serous papillary endometrial cancers (SPEC) that are refractive to therapy. Our results defined a "SPEC signature" as a molecular definition of its malignant features and poor prognosis. Specifically, we found that STAT1 regulated MYC as well as ICAM1, PD-L1, and SMAD7, as well as the capacity for proliferation, adhesion, migration, invasion, and in vivo tumorigenecity in cells with a high SPEC signature. Together, our results define STAT1 as a driver oncogene in SPEC that modulates disease progression. We propose that STAT1 functions as a prosurvival gene in SPEC, in a manner important to tumor progression, and that STAT1 may be a novel target for molecular therapy in this disease.

A Web-based health promotion program for patients with metabolic syndrome.

PURPOSE: The population of metabolic syndrome is increasing in Korea. The prevalence is related to lifestyle, such as lack of physical activity and irregular diet. Most patients with metabolic syndrome know that lifestyle intervention is important to managing the condition. However, they do not always follow the intervention for various reasons, including lack of knowledge on how to change their lifestyle and lack of accessibility to that knowledge. The purpose of this study was to test the web-based health promotion program we developed. METHODS: Fifty-six adult workers from eight areas of business were recruited. They all had a confirmed metabolic syndrome diagnosis after being registered at a university hospital for annual health checkups. Twenty-nine workers were assigned to the experimental group, and the others were assigned to the control group. The web-based program was applied to the experimental group as an intervention for 8 weeks. Waist circumference, fasting blood glucose, triglyceride, high-density lipoprotein cholesterol, and blood pressure were measured before and after the program. Data were analyzed using chi-square test, Fisher's exact test, and t test. RESULTS: There were statistically significant differences between the two groups in waist circumference and high-density lipoprotein cholesterol (t = -4.43, p < .001; t = 2.22, p = .031, respectively). Of the 29 participants, 13 (44.83%) in the intervention group had less than two indices for metabolic syndrome. CONCLUSIONS: This study suggests that a web-based program is useful for patients with metabolic syndrome to improve physiologic parameters related to metabolic syndrome. The web-based program may be easily applicable to community as well as clinical setting.

Isolation and characterization of novel microsatellite markers for the northern mauxia shrimp, Acetes chinensis, using pyrosequencing.

Among the 14 species in the Acetes genus, Acetes japonicus and Acetes chinensis, are the only and also abundant two species around the Korean Peninsula, and are used in traditional recipes. These species are of great economic importance, but little is known about their population genetics, despite the fact that information of this kind is important for stock assessment, fisheries management and identification of origin. A total of 9 microsatellite (MS) markers for A. chinensis were developed using pyrosequencing techniques. Polymorphisms of these markers were evaluated in 96 wild individuals collected from the Yellow Sea off the coast of Korea. A total of 133 alleles were detected at nine loci, with a cross-species transferability of 56% with A. japonicus. These markers will facilitate assessment of population genetic diversity in the genus Acetes.

Utilization of genomic signatures to identify high-efficacy candidate drugs for chemorefractory endometrial cancers.

Endometrial cancer, one of the most common gynecologic malignancies, is increasing in Japan, nearly doubling over the last decade. High-grade disease patients are often resistant to conventional chemotherapy with platinum agents; therefore, discovery of efficacious new drugs in this setting is required to benefit chemorefractory cases. The 50% growth-inhibitory (GI50) concentration of 27 clinically relevant drugs was measured in the NCI60 panel of cell lines. Gene expression data were analyzed using Bayesian binary regression, to first generate a response signature for each drug and then to calculate individual susceptibility scores using in vivo endometrial cancer data (GSE2109; http://www.ncbi.nlm.nih.gov/geo) and in vitro data (GSE25458), as well as to identify candidate drugs for chemorefractory cases. Using these candidates, cell proliferation, apoptosis and caspase assays were performed in vitro. The tumor growth-inhibitory effect of the candidate was also assessed in vivo using nude mice. Through microarray analysis, fludarabine and temsirolimus showed higher susceptibility scores in high-grade cases compared to cisplatin, doxorubicin and paclitaxel. Fludarabine significantly inhibited cell proliferation and increased apoptosis in the cisplatin-resistant endometrial cancer cell line, HEC1A, relative to HEC50B (p < 0.001). Fludarabine treatment also enhanced caspase-3/7 activity in HEC1A relative to HEC50B cells (p < 0.001), and inhibited the growth of HEC1A xenograft tumors relative to cisplatin (p < 0.05). These results support that identification and use of genomic signatures can lead to identification of new therapeutic candidates that may prove beneficial to chemoresistant cases. Fludarabine may be useful in targeting high-grade, chemorefractory endometrial cancer.

Characterizations of Shell and Mantle Edge Pigmentation of a Pacific Oyster, Crassostrea gigas, in Korean Peninsula.

The objectives of this study were to investigate color patterns of shell and mantle edge pigmentation of a Pacific oyster, C. gigas, and to estimate variance components of the two colors. A sample of 240 F0 oysters was collected from six aquaculture farms in Tongyeong, Korea to measure shell color and mantle edge pigmentation. Among the F0s, male and female individuals with black (white) shell and black (white) mantle edge were selected and mated to generate three F1 full-sib black (white) cross families (N = 265). Two and four F2 cross families (N = 286) were also produced from black and white F1 selected individuals, respectively. Variance component estimates due to residuals and families within color were obtained using SAS PROC VARCOMP procedures to estimate heritability of shell and mantle edge pigmentation. In the F0 generation, about 29% (11%) had black (white) color for both shell and mantle edge. However, in the F1 and F2 black (white) cross families, 75% (67%) and 100% (100%) of oysters had black (white) shell colors, and 59% (23%) and 79% (55%) had black (white) mantle edge, respectively. Spearman correlation coefficients between shell and mantle edge color were 0.25, 0.74, and 0.92 in F0, F1, and F2 generations, respectively, indicating that, with generations of selection process, an individual with black (white) shell color is more likely to have black (white) mantle edge pigmentation. This suggests that shell color could be a good indicator trait for mantle edge pigmentation if selection of both the colors is implemented for a couple of generations. Estimates of heritability were 0.41 and 0.77 for shell color and 0.27 and 0.08 for mantle edge pigmentation in the F1 and F2 generations, respectively, indicating that, in general, significant proportions of phenotypic variations for the shell and mantle edge colors are explained by genetic variations between individuals. These results suggest that the two color traits are inheritable and correlated, enabling effective selection on shell and mantle edge color.

[Effects of a home-based exercise program for patients with stomach cancer receiving oral chemotherapy after surgery].

PURPOSE: The purpose of this study was to identify the effects of a home based exercise program for patients with stomach cancer who were undergoing oral chemotherapy. METHODS: The home-based exercise program was developed from the study findings of Winningham (1990) and data from the Korea Athletic Promotion Association (2007). The home-based exercise program consisted of 8 weeks of individual exercise education and exercise adherence strategy. Participants were 24 patients with stomach cancer who were undergoing oral chemotherapy following surgery in 2007 or 2008 at a university hospital in Seoul. Patients were randomly assigned to either the experimental group (11) or control group (13). The effects of the home-based exercise program were measured by level of cancer related fatigue, NK cell ratio, anxiety, and quality of life. Data were analyzed using SPSS/WIN 13.0 version. RESULTS: The degree of cancer related fatigue and anxiety in the experimental group decreased compared to the control group. The NK cell ratio and the degree of quality of life of experimental group increased while that of the control group decreased. CONCLUSION: This study result indicate the importance of exercise and provide empirical evidence for continuation of safe exercise for patients with cancer during their chemotherapy.

The activated transforming growth factor-beta signaling pathway in peritoneal metastases is a potential therapeutic target in ovarian cancer.

Peritoneal dissemination including omental metastasis is the most frequent route of metastasis and an important prognostic factor in advanced ovarian cancer. We analyzed the publicly available microarray dataset (GSE2109) using binary regression and found that the transforming growth factor (TGF)-beta signaling pathway was activated in omental metastases as compared to primary sites of disease. Immunohistochemical analysis of TGF-beta receptor type 2 and phosphorylated SMAD2 indicated that both were upregulated in omental metastases as compared to primary disease sites. Treatment of the mouse ovarian cancer cell line HM-1 with recombinant TGF-ß1 promoted invasiveness, cell motility and cell attachment while these were suppressed by treatment with A-83-01, an inhibitor of the TGF-ß signaling pathway. Microarray analysis of HM-1 cells treated with TGF-ß1 and/or A-83-01 revealed that A-83-01 efficiently inhibited transcriptional changes that are induced by TGF-ß1. Using gene set enrichment analysis, we found that genes upregulated by TGF-ß1 in HM-1 cells were also significantly upregulated in omental metastases compared to primary sites in the human ovarian cancer dataset, GSE2109 (false discovery rate (FDR) q = 0.086). Therapeutic effects of A-83-01 in a mouse model of peritoneal dissemination were examined. Intraperitoneal injection of A-83-01 (150 µg given three times weekly) significantly improved survival (p = 0.015). In summary, these results show that the activated TGF-ß signaling pathway in peritoneal metastases is a potential therapeutic target in ovarian cancer.

Job analysis of clinical research coordinators using the DACUM process.

PURPOSE: This study was done to analyze the job of clinical research coordinators (CRCs). METHODS: Through the "developing a curriculum (DACUM)" workshop, the definition of CRCs' role was described and CRCs' duties and tasks were identified. Finally, the developed duties and tasks were validated for importance, difficulty, and frequency. RESULTS: A CRC is defined as the one who coordinates and performs tasks related to clinical research/trials among investigators, participants, and sponsors according to the Good Clinical Practice at institutions conducting clinical trials. Twelve duties and 78 tasks were identified on the DACUM chart which represented the importance, difficulty, and frequency of tasks represented as A, B, and C respectively. Based on determinant coefficient (DC) of the task, the highest ranked task was confirming the eligibility of participants for research (DC=8.03) and the lowest was inventory management for clinical study materials (3.95). CONCLUSION: In this study, the job of a CRC was analyzed through the DACUM process and it was found that CRCs were doing various duties and tasks. Based on these results, it is suggested that it is necessary to develop CRC education programs considering the career ladder of CRCs.

Analysis of mutations and the association between polymorphisms in the cerebral dopamine neurotrophic factor (CDNF) gene and Parkinson disease.

Neurotrophic factors support the survival of dopaminergic neurons. The cerebral dopamine neurotrophic factor (CDNF) is a novel neurotrophic factor with strong trophic activity on dopaminergic neurons comparable to that of glial cell line-derived neurotrophic factor (GDNF). To investigate whether rare or common variants in CDNF are associated with Parkinson disease (PD), we performed mutation analysis of CDNF and a genetic association study between CDNF polymorphisms and PD. We screened 110 early-onset Parkinson disease (EOPD) patients for CDNF mutations. Allelic and genotype frequencies of 3 CDNF single nucleotide polymorphisms (SNPs) (rs1901650, rs7094179, and rs11259365) were compared in 215 PD patients and age- and sex-matched controls. We failed to identify any mutations in CDNF among the EOPD patient sample population. We observed a trend towards increased risk for PD in patients carrying the C allele of SNP rs7094179 (odds ratio (OR)=1.27, 95% confidence interval (CI) 0.96-1.67). Patients carrying the C allele were susceptible to PD in both dominant (CC+CA vs. AA; OR=7.20, 95% CI 0.88-59.1) and recessive (CA+AA vs. CC; OR=0.64, 95% CI 0.41-0.99) models. Genotype and allele frequencies of SNPs rs1901650 and rs11259365 did not differ between PD patients and controls. Our study suggests that the C allele of an intronic CDNF SNP (rs7094179) might be an allele for susceptibility to PD. Further studies with larger sample size are required to confirm our results.

Endometrial cancer implanted within a cesarean section scar.

Several reports have documented adenocarcinoma arising from endometriotic implants within cesarean section (C-S) scars on the serosal surface of the uterus; however, endometrial cancer invading the C-S scar from the uterine cavity has not been described. We report a case of a grade 1 endometrioid adenocarcinoma 'drop' lesion invading a previous C-S scar with resultant cervical stromal invasion. Using both MR images and a thorough review of the pathology, the tumor at the C-S scar was determined to be an implant derived from a primary lesion at the uterine fundus. With increases in the incidence of both endometrial cancer and births by C-S, it is likely we will encounter more cases of iatrogenic implants of endometrial cancers in C-S scars.

GPR54 is a target for suppression of metastasis in endometrial cancer.

Invasion into deep myometrium and/or lymphovascular space is a well-known risk factor for endometrial cancer metastasis, resulting in poor prognosis. It is therefore clinically important to identify novel molecules that suppress tumor invasion. Reduced expression of the metastasis suppressor, kisspeptin (KISS1), and its endogenous receptor, GPR54, has been reported in several cancers, but the significance of the KISS1/GPR54 axis in endometrial cancer metastasis has not been clarified. Metastin-10 is the minimal bioactive sequence of genetic products of KISS1. Clinicopathological analysis of 92 endometrial cancers revealed overall survival is improved in cancers with high expression of GPR54 (P < 0.05) and that GPR54 expression is associated with known prognostic factors including FIGO stage, grade, and deep myometrial invasion. Through RNAi and microarray analyses, metastin-10 was predicted to suppress metastasis of GPR54-expressing endometrial cancers in vivo. Methylation analysis revealed GPR54 is epigenetically regulated. Metastin-GPR54 axis function was restored following treatment with the DNA hypomethylating agent 5-aza-DC. These data suggest that metastin-10 may be effective at inhibiting the metastatic spread of endometrial cancers in combination with demethylating agents to induce GPR54 expression.

[Evaluation of the Korean formal educational program for training care workers for frail elderly].

PURPOSE: This study was done to evaluate the formal education program provided by the Korean government for care workers for frail elderly people. METHODS: This study was a cross-sectional survey in which 438 certified care workers who had completed the education program participated. Data were collected from June to October 2009, using a self-report questionnaire consisting of satisfaction with, and understanding of the education program. RESULTS: The participants had a mean age of 46.7 yr, 87.9% were female and 58.2% were high school graduates. For the theory part of the education, the highest score for understanding was for'supporting household & activities of daily living' while the lowest score for understanding was for'care for death and dying'. For the practical education, the highest score for understanding was for'talking with the client' and the lowest score was for'first aid & basic life support'. There was a significant difference in satisfaction and understanding of the theoretical and practical parts according to educational level. CONCLUSION: Continuing education programs are needed for care workers for elders, both in the theoretical and practical areas. Also the content of programs should address the weak points of this formal education program.

Evaluation of the completeness of the nursing process for patients having gastrectomy using electronic nursing records.

The purpose of this study was to evaluate recording completeness of the nursing process. We compared nursing statements documented at the time when the Electronic Nursing Record (ENR) system, based on the ICNP, was implemented in 2004 with those documented in 2007. The ENRs for 35 gastrectomy patients in each year were selected for evaluation. The selected data were 11,822 nursing statements in 2004 and 27,870 in 2007. The results indicated a significant increase in the completeness of the nursing process in 2007. In addition, the number of nursing diagnosis increased by 5.1 times. The most contributing factor for this increase is assumed to be nurse education.

Effects of Meridian acupressure for stroke patients in Korea.

AIM: To examine the effects of Meridian acupressure on the functions of affected upper extremities, activity of daily living and depression for stroke patients. BACKGROUND: The handicaps of stroke patients necessitate multidisciplinary rehabilitation, which is aimed at decreasing the consequences of the illness in daily functions. In traditional Chinese medicine, Meridian acupressure has been used for rehabilitation of affected upper extremities of hemiplegia stroke patients in clinical practice. DESIGN: Randomised clinical trial. METHOD: Sample was 56 consecutive stroke patients in K Oriental hospital. Meridian acupressure was applied every day for 10 min per time in the experimental group (28 subjects) for two weeks. Routine care only was applied in the control group (28 subjects). Measures were a hand dynamometer for grip power, a 15-point graphic rating scale for pain, the distance round the index finger for oedema, electrogoniometry for the passive ROM of the upper extremities, the activity of daily living scale for activity of daily living and the six-face rating scale for depression. Data were collected from March 2003-September 2004. RESULTS: There were significant differences in functions of affected upper extremities, activity of daily living and depression between experimental and control group. CONCLUSIONS: Meridian acupressure was an effective intervention for improving the movement of the affected upper extremities, increasing activity of daily living and decreasing depression of hemiplegia stroke patients. RELEVANCE TO CLINICAL PRACTICE: Health professionals need to consider an array of methods including Meridian acupressure for the rehabilitation of stroke patients. Meridian acupressure has the potential as an alternative nursing intervention for multidisciplinary rehabilitation of stroke patients in practice.

[Development of a multimedia learning DM diet education program using standardized patients and analysis of its effects on clinical competency and learning satisfaction for nursing students].

PURPOSE: The purpose of this study was to develop a multimedia learning program for patients with diabetes mellitus (DM) diet education using standardized patients and to examine the effects of the program on educational skills, communication skills, DM diet knowledge and learning satisfaction. METHODS: The study employed a randomized control posttest non-synchronized design. The participants were 108 third year nursing students (52 experimental group, 56 control group) at K university in Seoul, Korea. The experimental group had regular lectures and the multimedia learning program for DM diet education using standardized patients while the control group had regular lectures only. The DM educational skills were measured by trained research assistants. RESULTS: The students who received the multimedia learning program scored higher for DM diet educational skills, communication skills and DM diet knowledge compared to the control group. Learning satisfaction of the experimental group was higher than the control group, but statistically insignificant. CONCLUSION: Clinical competency was improved for students receiving the multimedia learning program for DM diet education using standardized patients, but there was no statistically significant effect on learning satisfaction. In the nursing education system there is a need to develop and apply more multimedia materials for education and to use standardized patients effectively.

The effects of a weight loss program focusing on maternal education on childhood obesity.

PURPOSE: Childhood obesity is a matter of great concern because of its negative health and social consequences. We examined the effect of a weight control program focusing on maternal education on childhood obesity, given that the incidence of obesity is greatly affected by parents. METHODS: A two-group pre-test/post-test design was used. Participants consisted of 65 obese children and their mothers. The children were fourth- to sixth-grade elementary students who did not currently receive any therapy for weight loss. The children and their mothers were randomly assigned to either an experimental (n = 32) or a control group (n = 33). The 8-week intervention for mothers included one-time group education, three-time phone counseling, and four-time fliers regarding obesity management. Four outcomes (self-control, obesity index, abdominal circumference, and body fat percentage) were measured before and after the intervention. Chi-squared test or t test was used to test homogeneity between the two groups. Analysis of covariance was used to test the intervention effects. RESULTS: After the intervention was completed, the level of self-control was significantly heightened and obesity levels in the other three outcomes were greatly lowered in the experimental group when compared with the control group. CONCLUSION: Due to strong maternal effects on children's weight control, mothers' active participation must be encouraged in order to resolve childhood obesity.

Aquatic exercise in older Korean women with arthritis: identifying barriers to and facilitators of long-term adherence.

The purpose of this study was to identify factors influencing long-term adherence to aquatic exercise in older women with arthritis. Participants (n = 72) completed an educational program on aquatic exercise and underwent follow up for 6 months. At follow-up, women who continued aquatic exercise (adherence group, n = 25) had significantly higher scores than women in the nonadherence group (n = 47) in exercise self-efficacy (p < 0.0001) and group cohesion based on social aspects (p = 0.009). Both groups reported experiencing similar barriers to exercise (rho = 0.78). The findings provide insights for the development of strategies to promote long-term adherence to this type of aquatic exercise. Specifically, the findings encourage the fostering of exercise self-efficacy and social group cohesion during participation in educational programs to increase long-term exercise adherence.