Time to Diagnosis and Treatment of Diabetes Mellitus among Korean Adults with Hyperglycemia: Using a Community-Based Cohort Study.

OBJECTIVES: To identify the time from hyperglycemia to diabetes mellitus (DM) diagnosis and treatment, the risk factors for diabetes development, and the prevalence of comorbidities/complications in patients > 40 years of age. METHODS: This secondary data analysis study used data from the Korean Genome and Epidemiology Study. The participants comprised 186 patients who did not have diabetes at baseline, but developed hyperglycemia at the first follow-up. The average and median periods until DM diagnosis and treatment were calculated using Kaplan-Meier survival analysis. RESULTS: Of the 186 participants, 57.0% were men and 35.5% were 40-49 years old. The average time to DM diagnosis and treatment was 10.87 years and 11.34 years, respectively. The risk factors for the duration of DM were current smoking, body mass index (BMI), fasting blood sugar (FBS), and postprandial 2-hour glucose (PP2). The risk factors for the duration of diabetes treatment were current smoking, hypertension, BMI, FBS, and PP2. The development of one or more comorbidities or diabetes complications was identified at the time of DM diagnosis (36.5%) and DM treatment (41.4%). CONCLUSIONS: As diabetes complications occur at the time of DM, and early treatment can impact the development of diabetes complications or mortality, it is necessary to establish a referral program so that participants presenting with high blood sugar levels in the screening program can be diagnosed and treated in a timely manner.

Development of Financial Support Program for High Risk Pregnant Women.

OBJECTIVES: The purpose of this study was to develop a financial support program for high-risk pregnant women based on opinions obtained using a questionnaire survey. METHODS: The program development involved two steps: (1) developing a questionnaire through reviewing previous financial support programs for maternal care and then validating it via professional consultation; and (2) drafting a financial support program. Sixty professionals, 26 high-risk pregnant women, and 100 program implementers completed the questionnaire between August 2014 and October 2014. RESULTS: Based on the obtained professional consultation and survey investigation, the framework of the financial support program was constructed. The suggested recipients were mothers with early labor pains, mothers who have been hospitalized for > 3 weeks, and mothers who used uterine stimulant Pitocin during hospitalization. All hospitalization, medication, and examination costs needed to be supported considering the income level of the recipient. CONCLUSION: A basic policy for financially supporting high-risk pregnant women has been developed. The efficacy and feasibility of the policy needs to be carefully examined in future studies.

Understanding of Technical Terms and Contents of Informed Consent Forms for Sedative Gastrointestinal Endoscopy Procedures.

PURPOSE: This was a cross-sectional study designed to evaluate the subjective understanding of technical terms and contents of the informed consent forms given to patients about to undergo conscious sedative upper gastrointestinal endoscopy. METHODS: A group of conveniently selected 180 patients, who were undergoing sedative endoscopy were recruited in the endoscopy procedure room in a tertiary hospital from June to July 2011. Data were collected with a structured questionnaire. RESULTS: The average number of terms exposed was 8.12 out of 10 items, the average number of terms understood well by the patients was 5.53 out of 10 items, and the average number of right answers was 3.30 out of 5 items, and the percent of correct answers ranged from 26.1% to 90.0%. The exposure to terms differed by gender, education, and previous exposure to sedative endoscopy procedures. The number of "understanding of the terms well" responses differed according to age and previous exposure to sedative endoscopy procedures, and the correct answer rate was differed by education. CONCLUSION: The understanding of the terms and knowledge about the procedures were disappointing. Therefore, sufficient explanations should be provided to the patients. While the informed consent was taken by doctors, the level of understanding should be monitored by nurses. In particular, subjects who did not have any previous experience with endoscopy procedures showed relatively lower level of understanding. We recommend that medical terms should be replaced with more common and nontechnical words in consent forms.

Predictors of hearing protection behavior among power plant workers.

PURPOSE: This study aimed to identify factors affecting the use of the hearing protection devices (HPDs) among workers exposed to noise using the Pender Health Promotion Model. METHODS: The 222 subjects came from thermal power plants with similar noise levels, which are between 80 dB and 90 dB in South Korea. Data were collected with self-administered questionnaires designed to measure concepts from the Health Promotion Model. RESULTS: Mean percent times of using the HPDs at their most recent job site were 50.9%, and 20.3% had never the HPDs. The predictors of HPD use were social modeling (OR = 1.380), perceived benefits (OR = 1.150), and working at noisy worksites (OR = 4.925) when the outcome was based on the "non-use" versus "used at least once". However, the predictors of HPD use were social modeling (OR = 1.795) and perceived benefits (OR = 1.139) based on the "less than half-of-the-time-use" versus "more than half-of-the-time-use". CONCLUSION: Social modeling and perceived benefits of using the HPDs are important for workers to keep minimal or certain level of using the HPDs.

Comparison of Catheter-associated Urinary Tract Infection Rates by Perineal Care Agents in Intensive Care Units.

PURPOSE: This study compared the catheter-associated urinary tract infection (CAUTI) rates resulting from the use of four perineal care agents (soap-and-water, skin cleansing foam, 10% povidone-iodine, and normal saline) among patients in intensive care units (ICUs). METHODS: This four-group experimental study was done with 97 adult patients who had urinary catheters over 2 days in three ICUs between April and July 2008. The patients received one of the four types of perineal care. Data collected included the incidence of CAUTI at baseline (prior to perineal care) and 1 week, 2 weeks, and 4 weeks after beginning perineal care. Patients were divided into UTI and non-UTI groups based on the Centers for Disease Control and Prevention/National Healthcare Safety Network UTI definition to calculate incidence rates. The hazard ratio (HR) and 95% confidence intervals were calculated by Cox's proportional hazard analysis. RESULTS: The cumulative incidence of CAUTIs per 100 urinary catheter days were 3.18 episodes during 1 week with urinary catheter, 3.31 during 2 weeks, and 3.04 during 4 weeks. No statistically significant difference in hazard ratios of CAUTIs for each perineal care agent was evident with reference to soap-and-water at 1 week, 2 weeks, and 4 weeks after beginning perineal care after controlling for age, use of antibiotics, fecal incontinence, consciousness level, fever, and diabetes. CONCLUSIONS: The type of perineal care does not influence the incidence of CAUTIs. Further confirmatory studies with a larger patient population should be conducted, as well as determining perineal agent preference.

Compliance with standard precautions among operating room nurses in South Korea.

BACKGROUND: Standard precautions are widely adopted to prevent the transmission of bloodborne pathogens among health care workers. There is no system to monitor compliance with standard precautions among health care workers, and few studies have been done to identify the level of compliance with standard precautions among health care workers in South Korea. OBJECTIVES: This study aimed to determine the level of compliance with and education on standard precautions among operating room nurses in South Korea. METHODS: A cross-sectional survey was done with 158 operating room scrub nurses from 7 general hospitals that each had 500 beds or more in Busan, South Korea, from April to May 2006. Data were collected using self-administered questionnaires on compliance with double gloving, using protective eyewear, and no recapping of needles. RESULTS: Twelve percent (19/158) of the participants always used double gloving, 2% (3/158) always used protective eyewear, and 10% (15/158) always practiced not recapping used needles. All hospitals investigated in the study had regular educational programs lasting less than 1 hour on the control of hospital infection for new employees. Only 1 hospital has provided on the job training on the infection control for current operating room nurses. CONCLUSION: Operating room nurses in this study rarely complied with standard precautions, especially with using protective eyewear. Training on a more regular basis should be established to increase the compliance with standard precautions among operating room nurses in South Korea.

Needlestick and sharps injuries in a tertiary hospital in the Republic of Korea.

BACKGROUND: The high incidence of hepatitis B virus (HBV) in the Republic of Korea has focused attention on monitoring the occurrence and characteristics of needlestick and sharps injuries (NSIs) as part of an effort to reduce the occupational exposure to bloodborne pathogens such as HBV. This study investigated NSIs reported in a tertiary referral hospital in Busan, Republic of Korea over a 6-year period (2001 to 2006). METHOD: Data on the number of NSIs, places where NSIs occurred, devices causing injury, purpose of using sharps, and circumstances surrounding NSIs were collected from the study hospital's NSI database. The incidence of NSIs per 100 full-time equivalent (FTE) employees was calculated by year and by profession. RESULTS: A total of 221 NSI cases were reported during the study period. Overall incidence was 2.6 cases per 100 FTE employees per year, with the highest rate occurring in interns (17.7 cases per 100 FTE interns per year). Some 34% of cases occurred in the ward, needles were the most common device causing injury (73%), and the most common circumstance surrounding an NSI was after sharps use and before disposal (24%). CONCLUSION: The pattern of NSI occurrence found in this study was comparable to that reported in previous studies. However, the overall incidence of NSIs was significantly lower than that in previous studies, apparently related to underreporting of NSIs. Further research to investigate reasons for this underreporting is recommended. Considering the high incidence of NSIs in interns, in-service training for this group should be enhanced.

[Effects of a newborn care education program on newborn care confidence and behavioral accuracy of primiparas in a postpartum care center].

PURPOSE: The study aimed to identify the effects of a newborn care education program on newborn care confidence and behavioral accuracy of primiparas in a postpartum care center. METHOD: This was a quasi-experimental study with a non-equivalent control group non-synchronized design. Subjects were 29 primiparas selected from a postpartum care center in D and P hospitals in Ulsan. The intervention was a newborn care education program which was composed of education with a booklet, demonstration, watching a video, and verbal encouragement. The outcome variables were newborn care confidence and behavioral accuracy. Data was collected from Feb. 1 to Mar 22 in 2005 with self-administered questionnaires and observation by researchers. Data was analyzed using the chi(2)-test, Fisher's exact test, t-test and ANCOVA. RESULT: The experimental group showed significantly higher score changes between the pre-test and post-test in confidence and behavioral accuracy than the control group. CONCLUSION: The newborn care education program showed positive effects on newborn care confidence and behavioral accuracy of primiparas in a postpartum care center. Therefore, we recommend that this program should be applied in postpartum care centers.

[A study on influencing factors in health promoting behaviors of women workers at small-scale industries].

PURPOSE: This study was aimed to identify the major factors affecting performance in health promoting behaviors in women workers at small-scale industries. METHOD: This study was based on the Pender's Health Promotion Model. The subjects for this study were 251 women workers at 23 small-scale industries in Busan city. The data for this study was collected from July 15th to August 15th 2003 by structured questionnaires, and were analyzed with ANOVA, t-test, Pearson' correlation coefficient, and multiple Regression in the SPSS/WIN 10.0. RESULT: The mean performance of the health promoting behavior was 2.56. The factors related to the performance of the health promoting behaviors were social support, marital status, status of owning a house, perceived barriers to action, working time, and self-efficacy, and they explained 58.4% of the variance of the health promoting behaviors. CONCLUSION: The mean performance of the health promoting behavior seemed to be low, and the most important variable related to health promoting behaviors of women working at a small-scale industry was social support. Therefore, intervention programs to increase the social support for women worker need to be developed.

[Breast cancer screening and repeat screening].

PURPOSE: This study was to investigate the characteristics and related factors of breast cancer screening and repeat screening, and to propose nursing interventions to increase the rate of breast cancer screening and repeat screening. METHOD: Study subjects was 236 women residing in the community, teachers and nurses who were older than 45 were recruited. Data was collected with self administered questionnaires from July 1st to August 31st, 2003 and analysed using SPSS/WIN 10.0 with X(2)test, t-test, and stepwise multiple logistic regression at a significant level of =.05. RESULT: The breast cancer screening rate was 57.2%, and repeat screening rate was 15.3%. With the multiple logistic regression analysis, factors associated with mammography screening were age and perceived barriers of action, and factors related to the repeat mammography screening were education level and other cancer screening experience. CONCLUSION: Based on the results, we recommend the development of an intervention program to decrease the perceived barrier of action, to regard mammography as an essential test in regular check-up, and to give active advertisement and education to the public to improve the rates of breast cancer screening and repeat screening.

[The effect of self-foot reflexology on the relief of premenstrual syndrome and dysmenorrhea in high school girls].

PURPOSE: This study was aimed to identify the effect of self-foot reflexology on the relief of premenstrual syndrome and dysmenorrhea in high school girls. METHOD: Study subjects was 236 women residing in the community, teachers and nurses who were older than 45 were recruited. Data was collected with self administered questionnaires from July 1st to August 31st, 2003 and analysed using SPSS/WIN 10.0 with Xtest, t-test, and stepwise multiple logistic regression at a significant level of =.05. RESULT: The breast cancer screening rate was 57.2%, and repeat screening rate was 15.3%. With the multiple logistic regression analysis, factors associated with mammography screening were age and perceived barriers of action, and factors related to the repeat mammography screening were education level and other cancer screening experience. CONCLUSION: Based on the results, we recommend the development of an intervention program to decrease the perceived barrier of action, to regard mammography as an essential test in regular check-up, and to give active advertisement and education to the public to improve the rates of breast cancer screening and repeat screening.

[Developing a computerized reminder system and evaluating the effects on the improvemtent of cancer screening].

PURPOSE: This study was aimed to develop a computerized reminder system and evaluate it's effect in terms of percent age change of screening, and satisfaction. METHOD: It was conducted through 6 phases : Analyzing the job and defining the basic input data, developing the information system, collecting and inputing data, testing the system, working with the system, and evaluating it's effect. Participants were 787 people (female 30-69 years, and males 40-49 years) in 2 dong of Suyoung gu, Busan, who haven't had cancer screening for the stomach, breast, or cervix since Dec. 2000. There were three experimental groups: a letter; calling and calling after the letter reminder, and a non-equivalent control group. To determine whether services were obtained, a telephone survey was done after two months of follow-up. RESULT: A cancer screening information system with five DB modules was developed. Overall compliance with screening was not statistically significantly changed before and after applying computerized reminders for all three screening sites. Only 16% were satisfied with the reminder. CONCLUSION: This data didn't show that a reminder effort was effective of screening. However, because the evaluation interval was too short to find a difference in screening rate, we recommend additional longer prospective follow up studies.

[Development and effect analysis of web-based instruction program to prevent elementary school students from safety accidents].

PURPOSE: This study was aimed to develop a WBI(Web Based Instruction) program on safety for 3rd grade elementary school students and to test the effects of it. METHOD: The WBI program was developed using Macromedia flash MX, Adobe Illustrator 10.0 and Adobe Photoshop 7.0. The web site was http://www.safeschool.co.kr. The effect of it was tested from Mar 24, to Apr 30, 2003. The subjects were 144 students enrolled in the 3rd grade of an elementary school in Gyungju. The experimental group received the WBI program lessons while each control group received textbook-based lessons with visual presenters and maps, 3 times. Data was analyzed with descriptive statistics, and chi2 test, t-test, and repeated measure ANOVA. RESULT: First, the WBI group reported a longer effect on knowledge and practice of accident prevention than the textbook-based lessons, indicating that the WBI is more effective. Second, the WBI group was better motivated to learn the accident prevention lessons, showing that the WBI is effective. As a result, the WBI group had total longer effects on knowledge, practice and motivation of accident prevention than the textbook-based instruction. CONCLUSION: We recommend that this WBI program be used in each class to provide more effective safety instruction in elementary schools.

[Effect of progressive muscle relaxation using biofeedback on perceived stress, stress response, immune response and climacteric symptoms of middle-aged women].

PURPOSE: This study was aimed to evaluate the effect of progressive muscle relaxation training using biofeedback on perceived stress, stress response, immune response and climacteric symptoms. METHOD: This was a crossover, pre-post test design. The study subjects are 36 middle-aged women who were selected at 2 public health centers. The independent variable was Biofeedback training for 4 weeks, twice a week and home training for 4 weeks. Dependent variables were perceived stress, stress response, immune response, and climacteric symptoms measured with Hildtch's scale (1996). RESULT: Progressive muscle relaxation training using biofeedback was not effective in reducing perceived stress, but it was shown to be effective in reducing physiological stress responses such as pulse rate and EMG. Though blood pressure and skin conductance were repeatedly down, and skin temperature slowly increased, there were no statistically significant differences. Progressive muscle relaxation training using biofeedback was not effective in reducing serum cortisol, enhancing immune responses, or decreasing climacteric symptoms. CONCLUSION: The findings point to a pressing need for further, well-controlled and designed research with consideration in selection of subjects and instruments, frequency of measurements, the sampling method, and intervention modalities.

[The effects of a stretching exercise program in elderly women].

PURPOSE: This study was aimed to identify the effects of a ten-week stretching exercise program on physiological, psychological functions, and activities of daily living(ADL) among elderly women. METHOD: Using a quasi-experimental design, the experimental group received a ten-week stretching exercise program 3 times a week from March to May in 2002. They were divided into 22 persons in the experimental groups in 2 halls where the program was incorporated, and 22 persons in the control group in 2 halls, where the program was not incorporated. Data was analyzed with descriptive statistics, the chi-square test, Fisher's Exact test, and ANCOVA was considered significant as a 2-tailed test. RESULT: There was a significant improvement in diastolic blood pressure(P=0.023), total cholesterol (P=0.019), triglycerides (P=0.002), spine ROM(P=0.000), trunk and hip-joint ROM(P=0.000), percent of body fat(P=0.039) as physiological functions, depression(P=0.041) as a psychological function, and activities of daily living(P=0.001) in the experimental group compared to the control group. CONCLUSION: A stretching exercise program showed good effects on improving physiological functions, psychological functions and activities of daily living among the elderly women in a city. Therefore, we recommend this program be utilized as a health promoting program for the elderly in the community.

Validity of pressure ulcer risk assessment scales; Cubbin and Jackson, Braden, and Douglas scale.

This study was to compare the validity of three pressure ulcer risk tools: Cubbin and Jackson, Braden, and Douglas scales. Data were collected three times per week from 48 to 72 h after admission based on the three pressure ulcer risk assessment scales and skin assessment tool developed by the Panel for the Prediction and Prevention of Pressure Ulcers (1994) from 112 intensive care unit (ICU) patients in a educational hospital Ulsan, Korea during December 11, 2000 to February 10, 2001. When a patient developed a pressure ulcer at the time of assessment, the patient was classified into 'pressure ulcer group', and when patients did not have a pressure ulcer until they died, moved to other wards or were discharged from the hospital, they were classified into 'not pressure ulcer group'. Four indices of validity and area under the curves (AUC) of receiver operating characteristic (ROC) were calculated. Based on the cut-off point presented by the developer, sensitivity, specificity, positive predictive value, negative predictive value were as follows: Cubbin and Jackson scale: 89%, 61%, 51%, 92%, respectively, Braden scale: 97%, 26%, 37%, 95%, respectively, and Douglas scale: 100%, 18%, 34%, 100%, respectively. AUCs of ROC curve were 0.826 for Cubbin and Jackson, 0.707 for Braden, and 0.791 for Douglas. Overall, the Cubbin and Jackson scale showed the best validity among scales tested and we recommended it for this ICU.

The prevalence of dementia in a metropolitan city of South Korea.

BACKGROUND: There are few studies on the prevalence of dementia in South Korea. This study was designed to estimate the prevalence rate of dementia in a metropolitan city of South Korea, Busan. METHODS: This was a cross-sectional epidemiological study of 1101 residents aged 65 or over in a metropolitan city (Busan) as of 31 December 2001 who were selected with the stratified three-stage cluster sampling. Dementia was assessed by two-stage examination with Mini-Mental State Examination-Korean version (MMSE-K), psychometric measures and the Barthel index. Crude and sex-age adjusted prevalence rate were obtained. RESULTS: The crude rate was 7.4% (men 2.4%, women 10.5%). The sex-age adjusted rate was 7.0% (men 2.5%, women 9.0%) and 8.0% (men 2.7%, women 10.0%) when adjusted with Busan and whole Korean population, respectively. CONCLUSION: These results were lower than those of other domestic studies. This is the first well-designed total-population based epidemiologic study on the prevalence rate of dementia of the aged residing in Busan city. Further studies for evaluating the relationships with type and severity of dementia are needed.

[The effect of handwashing improving program and MRSA carrier screening program on the MRSA infection rates in an intensive care unit].

PURPOSE: To assess the effect of handwashing improving program and MRSA carrier detection program on MRSA(methicillin resistant Staphylococcus aureus) infection rate in a intensive care unit. METHOD: The intervention was Nosocomial Infection(NI) control program consisted of hand washing improving program and identification and treatment of MRSA carrier. Data on the NI and MRSA infections were collected by an infection control nurse based on the definition of CDC. MRSA infection rates were calculated by the number of MRSA infection per 100 admissions or 1,000 patients-days. The difference of MRSA infection rates between pre and post intervention was tested by Chi-square at =.05. RESULT: MRSA infection rates 3.0% or 3.2 per 1,000 patient-days at the pre, 4.6% or 3.7 per 1,000 patient-days at the post, and the differences were not statistically significant (p=.411, p=.769 respectively). CONCLUSION: The handwashing improving program and MRSA carrier detection program was not effective in reducing the Nosocomial Infection(NI) or MRSA infection rates. It is recommended further studies with a longer intervention and follow-up period.

[A study to the coping patterns of cancer patients].

PURPOSE: This was to describe the emotions that patients face when diagnosed with cancer to know the problems and coping styles that cancer patients experience during the treatment. METHOD: The qualitative method was used for this study. The participants were 90 cancer patients at five general hospital in Pusan, Korea. Data were collected by interviews with a semi-structured questionnaire from November 2000 to June 2001, and were analyzed using the modified constant comparative method. RESULT: The most common emotions on the diagnosis of cancer were shock(36.7%), followed by despair(25.6%), acceptance(24.4%), denial(18.9%), complaint(16.7%), and fear(8.9%). The problems identified were the unpleasantness and physical discomfort related with the treatment(50.0%), the feelings of burden(41.1%), finance/occupation(38.8%), and fear of the future(26.6%). Coping styles to problems that the subjects have faced on the course of the treatment were compliance(36.6%), health care(31.1%), positive thinking(22.2%), despair/avoidance(15.5%), seeking social support(6.6%), information seeking(3.3%) and self-control(2.2%). CONCLUSION: It is very important to develop nursing interventions which can mitigate shock that patients experience, can help cancer patients to have hope for the future and to positively cope with cancer.

[Health related quality of life among organ transplant recipients].

PURPOSE: This study was aimed to investigate the health related quality of life and related factors of organ transplant recipients. METHOD: The participants were 188 people who had liver(86), kidney(81), or heart(24) transplanted. Data on the demographic characteristics, transplantation-related characteristics, symptom frequency or discomfort measured by Transplant Symptom Frequency and Symptom Distress Scale by Lough et al(1987), and health related quality of life measured by SF-36(version 2) were collected. RESULT: Overall health related quality of life score was 492.1 for 100 scoring and, 344.9 for norm based. Physical functioning showed the highest quality of life score (77.5) and vitality showed the lowest(51.1). The kidney transplanted showed the highest quality of life (504.4) and the heart transplanted showed the lowest(426.7) Quality of life was related with occupation(p=.016) and symptom discomfort(p<.0001). CONCLUSION: The health related quality of life of transplated patients was lower than the norm of American. Further studies need to be done to identify the norm of Korean and to investigate the effect of releving symptom discomfort on the increasing the health related quality of life.