Effects of an urban forest healing program on cancer-related fatigue in cancer survivors.

PURPOSE: This study aimed to examine the effects of an eight-session structured urban forest healing program for cancer survivors with fatigue. BACKGROUND: Cancer-related fatigue (CRF) is a complex and multifactorial common symptom among cancer survivors that limits quality of life (QoL). Although health benefits of forest healing on physiological, physical, and psychological aspect as well as on the immune system have been reported in many studies, there is limited evidence on the efficacy of specialized forest program for cancer survivors. METHOD: A single-blinded, pre-test and post-test control group clinical trial was conducted with -75 cancer survivors assigned to either the forest healing group or the control group. The intervention was an eight-session structured urban forest program provided at two urban forests with easy accessibility. Each session consists of three or four major activities based on six forest healing elements such as landscape, phytoncides, anions, sounds, sunlight, and oxygen. Complete data of the treatment-adherent sample (≥ 6 sessions) was used to examine whether sociodemographic, clinical, physiological (respiratory function, muscle strength, balance, 6-min walking test) and psychological (distress, mood state, sleep quality, QoL) characteristics at baseline moderated the intervention effect on fatigue severity at 9 weeks. RESULTS: Significant time-group interactions were observed muscle strength, balance, 6-min walking test, distress, fatigue, moods, and QoL. The mean difference in fatigue between pre- and post-forest healing program was 9.1 (95% CI 6.2 to 11.9), 11.9 (95% CI 7.6 to 16.1) in moods, and -93.9 (95% CI -123.9 to -64.0) in QoL, showing significant improvements in forest healing group, but no significant improvements in the control group. CONCLUSION: This study suggests that a forest healing program positively impacts the lives of cancer survivors, by addressing both physical and psychological challenges associated with CRF. TRIAL REGISTRATION NUMBER: KCT0008447 (Date of registration: May 19, 2023).

Priority Analysis of Educational Needs of Forest Healing Instructors Related to Programs for Cancer Survivors: Using Borich Needs Assessment and the Locus for Focus Model.

This study aimed to identify the priority of educational needs to strengthen the competency of forest healing instructors who operate forest healing programs for cancer survivors. A survey was conducted with 91 forest healing instructors using a questionnaire. The average perceived importance of the forest healing program for cancer survivors of forest healing instructors was higher compared to the average knowledge of the forest healing instructors. The Borich needs assessment model showed the highest educational need in the domains of "Cancer survivors' overview" and "Health status screening method". In addition, deriving the priority of educational needs using the Borich needs assessment model and the focus trajectory model revealed that the highest priority was for "Health status screening method" and "Effective communication with cancer survivors". These results can be used as basic data for developing a forest healing instructors training program for cancer survivors that reflects the instructors' needs and the characteristics of cancer survivors.

Distress among Korean Cancer Survivors: A Latent Profile Analysis.

This study aimed to classify cancer survivors' latent profile analysis (LPA) according to the problem list and identify the differences in distress between subgroups. Furthermore, this study identified differences between subgroups based on their demographic and clinical characteristics. A self-reported cross-sectional survey was administered to 446 adult cancer survivors in Korea. A distress thermometer and problem list were used, and four domains of the problem list were used to perform LPA and create subgroups. Quade's non-parametric analysis of covariance was used to determine the difference in distress between the profiles. The three identified subgroups of the problem list were: "low problem group" (36.7%), "high problem group" (49.1%), and "family only low problem group" (14.2%). The analysis showed that there was a difference in the distress level according to the sub-profile of the problem list (F = 43.69, p < 0.001). In interventions for distress, integrative interventions that are not limited to one area are necessary, and cultural characteristics as well as the problem list relevant to cancer survivors should be considered.

Analysis of Urban Forest Healing Program Expected Values, Needs, and Preferred Components in Urban Forest Visitors with Diseases: A Pilot Survey.

Although the effectiveness of urban forest therapy has been studied and proven, most people are not well aware of the positive healing effects of urban forests that are easily accessible in daily life compared to the known healing effect of forests located outside urban areas. In addition, there has been a study on the analysis of urban forest healing program needs in the general population, but there is a lack of evidence on the expected values and needs of urban forest healing for people with diseases. Therefore, this pilot survey aimed to investigate the expected values, needs, and preferred components of urban forest healing programs in urban forest visitors with disease via an online user survey and see if there were any differences in the purpose of the urban forest visits and expected values of urban forest healing depending on the type of disease. The survey was conducted on 294 urban forest visitors with diseases. About 79% of respondents agreed with the healing effects of urban forest, however most respondents expected healing effects on mental health rather than on physical health ("mood change" was the highest with score of 4.43/5, followed by "reliving stress" (4.35/5) and "mental and physical stability" (4.31/5)). In addition, more than 82.0% of respondents agreed to participate in the program if a healing program for disease was developed. The results of the current pilot survey indicate that the purpose of the urban forest visits and expected values of urban forest healing were largely not different by the type of disease, and people with disease had a relatively lower awareness and lower expected values of urban forest healing effects on physical health, but high demand for the program. Urban forest therapy programs should be developed based on the specific clinical characteristics of the disease to maximize the effectiveness of the program. Additionally, policies should be implemented to promote the beneficial effects of urban forest healing not only for mental health but also for physical health.

Experience of Violence and Factors Influencing Response to Violence Among Emergency Nurses in South Korea: Perspectives on Stress-Coping Theory.

INTRODUCTION: This cross-sectional study aimed to explore the experiences of workplace violence involving emergency nurses and to identify the factors influencing the response to violence on the basis of the stress-coping theory formulated by Lazarus and Folkman. METHODS: Using a cross-sectional design, a structured questionnaire was administered to measure the experience of violence, perceived stress, coping actions after violence, resilience (Connor-Davidson Resilience Scale), and responses to violence. The participants were 131 nurses who were working in the emergency departments in 9 of 11 general hospitals in 2 cities in South Korea. The collected data were analyzed using descriptive statistics, t tests, analyses of variance, Pearson correlations, and hierarchical multiple regression analyses. RESULTS: The most frequent type of violence was verbal violence, and the main offender involved in all types of violence was the patient. The methods for coping with violence were mainly passive, and emotional responses were the most frequently reported response to violence. In the final model (explanatory power = 41.5%), with response to violence as the dependent variable, the effects of the experience of violence disappeared, and only the effects of perceived stress and resilience remained. DISCUSSION: The results of this study suggest that internal factors such as perceived stress and resilience have a more meaningful effect on the response to violence than the experience of violence itself. The findings are expected to serve as assessment data for preparing interventions and policies around prevention of, and effective coping regarding, workplace violence toward emergency nurses.

Gender Differences in Sexual Behaviors and Their Relevance to Mental Health among High School Students with Sexual Experience in South Korea.

We explored gender differences in sexual behavior, and their relevance to mental health among high school students in South Korea. This study was based on data from the 14th Korea Youth Risk Behavior Web-Based Survey (2018). The subjects were 2460 high school students who reported sexual experiences. Student's t-test, ANOVA, and Rao-Scott chi-squared test were performed to identify the significance of the differences. Boys had earlier sexual debuts (Rao-Scott χ2 = 53.55, p < 0.001), a lower frequency of using contraceptives (Rao-Scott χ2 = 26.57, p < 0.001), and lower rates of sex education in school (Rao-Scott χ2 = 11.20, p = 0.004). With respect to mental health factors, there was a difference in suicidality according to sexual risk behaviors, with a stronger association found in boys. In girls, there was an association between pregnancy experiences and suicidal ideation (Rao-Scott χ2 = 9.90, p = 0.003), plans (Rao-Scott χ2 = 17.25, p < 0.001), and attempts (Rao-Scott χ2 = 23.11, p < 0.001). Our findings suggest differences by gender and age group in the association between sexual behavior and mental health. It is necessary to devise a sex education strategy for adolescents considering gender and early versus late adolescent development period.

Validation of the Korean Version of Impact of Event Scale-Revised (IES-R) in Korean Nurses during the COVID-19 Pandemic.

Nurses working amid the COVID-19 pandemic are at increased risk of developing post-traumatic stress disorder (PTSD). This study was conducted to verify the reliability and validity of the Korean version of Impact of Event Scale-Revised (IES-R), one of the most used tools for assessing trauma. Secondary data of 249 nurses who performed face-to-face nursing tasks during the COVID-19 pandemic, collected through an online survey, were analyzed by conducting a factor analysis of the K-IES-R and testing the internal consistency and concurrent validity with the Perceived Stress Scale (PSS), Generalized Anxiety Disorder Screener (GAD-7), and Dimensions of Anger Reactions-5 (DAR-5). The result of an exploratory factor analysis of the K-IES-R supported a three-factor structure of intrusion, avoidance, and sleep disturbance, with CMIN/DF = 2.98, RMSEA = 0.09, SRMR = 0.03, CFI = 0.93, and TLI = 0.90. The Cronbach's alpha of each subscale was 0.88-0.94. The total K-IES-R score and each factor's value showed a significant correlation (moderate or higher) with the PSS, GAD-7, and DAR-5. The K-IES-R was verified as a useful tool for assessing post-traumatic stress symptoms in nurses who directly perform nursing tasks in crises such as COVID-19. This study suggests the tool be used for early assessment of post-traumatic stress symptoms in nurses and providing appropriate interventions.

Gender Differences in Lifestyle and Mental Health among Senior High School Students in South Korea.

Gender differences in health outcomes have long been a concern worldwide. We investigated the gender differences in the lifestyle and mental health status of senior students in general high schools who were preparing for college entrance exams. This secondary analysis was based on data from the 14th Korea Youth Risk Behavior Web-Based Survey (2018). The data of 8476 students in the third year (12th grade) of general high school, among a total of 60,040 middle and high school students nationwide, were analyzed. Mean and standard error (SE) and weighted percentage data were obtained, and the Rao-Scott χ2 test was performed. Boys reported more risky behaviors related to drinking and smoking, while girls had more negative perceptions of their bodies and overall health. In addition, girls showed unhealthier lifestyle-related behaviors (breakfast, physical activity, weight control) and greater vulnerability to poor mental health, including lower sleep satisfaction, stress, depression, and suicidal thoughts. Our results suggest that education and health institutions should consider the needs of each gender separately. A gender-specific approach to maintaining healthy lifestyles and good health status among senior high school students is highly recommended.

Determination of Motivating Factors of Urban Forest Visitors through Latent Dirichlet Allocation Topic Modeling.

Despite the unique characteristics of urban forests, the motivating factors of urban forest visitors have not been clearly differentiated from other types of the forest resource. This study aims to identify the motivating factors of urban forest visitors, using latent Dirichlet allocation (LDA) topic modeling based on social big data. A total of 57,449 cases of social text data from social blogs containing the keyword "urban forest" were collected from Naver and Daum, the major search engines in South Korea. Then, 17,229 cases were excluded using morpheme analysis and stop word elimination; 40,110 cases were analyzed to identify the motivating factors of urban forest visitors through LDA topic modeling. Seven motivating factors-"Cafe-related Walk", "Healing Trip", "Daily Leisure", "Family Trip", "Wonderful View", "Clean Space", and "Exhibition and Photography"-were extracted; each contained five keywords. This study elucidates the role of forests as a place for healing, leisure, and daily exercise. The results suggest that efforts should be made toward developing various programs regarding the basic functionality of urban forests as a natural resource and a unique place to support a diversity of leisure and cultural activities.

Leisure Factors Predicting the Happiness of Self-Employed Workers in South Korea.

South Korea's employment status is characterized by a high rate of self-employment and many small-scale self-employed businesses with no employees. This study explored leisure factors relating to self-employed individuals' subjective happiness based on data from the 2019 National Leisure Activity Survey. The extracted data (N = 2343) were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, Kendall's τb coefficient, Eta correlation coefficient, phi coefficient, and Cramer's V. And a three-step hierarchical regression analysis was performed to identify multidimensional variables that predict happiness more effectively. In Model 3, which additionally inserted positive and intrinsic factors into Model 2, the explanatory power was significantly increased. The predictors of subjective happiness among self-employed people identified in the final regression model were high economic status (ß = 0.05), perceived health status (ß = 0.32), financial constraints (ß = -0.09), leisure recognition (ß = 0.20), and work-life balance (leisure-oriented ß = 0.09; work-oriented ß = -0.13). This study's findings will contribute to the establishment of basic data, to prepare empirical measures to improve self-employed individuals' quality of life.

Market Segmentation by Motivations of Urban Forest Users and Differences in Perceived Effects.

The purpose of this study aims at segmenting the urban forest users' market by motivation and analyzing the difference in perceived effects of urban forests. Based on a literature review, the study selected seven motivating factors of urban forest users: experiential activity, relaxatin/healing, health management, escape from everday life, daily leisure, affinity toward nature. Data were collected online from 21 to 29 Sepember 2020 with urban forest visitors. We analyzed 878 questionnaires received from those with experience of visiting an urban forest within the previous 24 months. We performed a cluster analysis to classify the subjects according to the characteristics of urban forest utilization, and assigned them to four clusters (rest in nature, family leisure, passive participation, and multiple pursuit). An additional analysis was performed to determine intergroup differences, which revealed differences in perceived benefits and healing effects of urban forests as well as satisfaction. The results of this study provide implications for urban forest operation and strategy setup.

Moderating Effect of Mindfulness on the Influence of Stress on Depression According to the Level of Stress among University Students in South Korea.

Stress and depression are representative of the mental health problems of university students worldwide. This cross-sectional study explored the moderating effect of mindfulness on the influence of stress on depression according to the degree of life stress. The participants were 738 university students in years 2-4 in five 4-year universities in South Korea. Depression was positively correlated with stress and negatively with mindfulness at a statistically significant level. In multiple regression analysis, stress was found to have an effect by increasing depression, and mindfulness by relieving depression. In the moderated multiple regression analysis, mindfulness had a moderating effect on the impact of stress on depression only in low-stress groups, showing that the interaction of stress with mindfulness was significantly negative (ß = -0.11, t = -2.52, p = 0.012) and the inclusion of this interaction significantly increased the explanatory power for depression variation (F change 6.36, p = 0.012) in the full model. In conclusion, we suggest considering stress levels in the development of mindfulness-based intervention strategies to effectively manage the depression of university students.

[Development of a structural equation model to estimate university students' depression].

PURPOSE: This study was designed to construct a structural model explaining depression in university students. METHODS: Data were collected from 1,640 university students by questionnaire, and analyzed using AMOS 5.0 to test the hypothetical model. RESULTS: Fitness statistics for the modified model were GFI=.93, AGFI=.89, NFI=.91, and RMSEA=.081. All the 12 paths in the modified model proved to be statistically significant. Depression of university students accounted for 52% of the covariance by the factors. The factor that had the most influence on depression was individual vulnerability, and followed by sequence order, stress, social support, coping, and self-efficacy. Depression was influenced directly by individual vulnerability, stress, social support, and coping, and indirectly by individual vulnerability, stress, social support, and self-efficacy. CONCLUSION: A screening and management system for the high risk group is needed to effectively prevent depression and reduce rate of depression in university students. Detailed support programs which specifically deal with prevailing stressors should be developed to effectively reduce the harmful effects of individual vulnerability and stress. It is anticipated that the model constructed in this study could be utilized as a reference in developing various strategies to prevent and intervene depression in university students.