Properties of Patient-Reported Outcome Measures for Post-Traumatic Stress Disorder in North Korean Defectors: A Scoping Review

Objective@#Posttraumatic stress disorder (PTSD) is highly prevalent among North Korean defectors. This scoping review aimed to appraise the measurement properties of patient-reported outcome measures (PROMs) that assess PTSD among North Korean defectors. @*Methods@#A systematic search was conducted using Research Information Sharing Service, ScienceON, PubMed, and Embase from their inception up to September 15, 2022. Each measurement properties of the included PROMs were evaluated using COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) methodology. First, the methodological quality of each study on measurement properties was evaluated using the COSMIN Risk of Bias checklist. Second, the result of each single study on a measurement property was rated against the updated criteria for good measurement properties. @*Results@#After screening the articles, nine instruments from 40 studies were included. Among these instruments, Impact of Event ScaleRevised was the most frequently used (13 studies [38.1%]), followed by the Trauma Scale for North Korean Refugees, PTSD Checklist, and Posttraumatic Diagnostic Scale. The theoretical basis of all PROMs was secure in terms of content validity. The most frequently tested characteristics in measurement properties for internal structure were internal consistency, criterion validity, and convergent validity. No study reported sufficient structural validity as confirmatory factor analysis results with a model fit. @*Conclusion@#There is insufficient evidence to support the recommendation of a specific PROM for use among North Korean defectors with PTSD.

Role of Oxytocin in Post-traumatic Stress Disorder: A Systematic Review

Purpose@#Recently, oxytocin has been introduced experimentally as a pharmacological treatment for post-traumatic stress disorder (PTSD). This study attempted to investigate the possibility of oxytocin as a treatment option for patients with PTSD by examining its dose, interval, and effectiveness in patients with PTSD. @*Methods@#A systematic review was done on articles published from 1967 to 2020 using the PubMed, PsycINFO, and Cochrane databases. Our inclusion criteria were 1) subjects 18 years of age or older diagnosed with PTSD or exposed to a traumatic event that met criterion A of the Diagnostic and Statistical Manual of Mental Disorders (DSM) for PTSD, 2) oxytocin was administered at least once, 3) clinical trials, and 4) studies published in Korean or English. Two independent researchers reviewed 22 articles and recorded the contents. The risk of bias was evaluated to determine the quality of the reviewed article. @*Results@#The parameters for evaluating the effectiveness of oxytocin were identified as socio-behavioral measures in 11 articles, neuronal imaging in 9, and biomarkers in 4. In 5 papers, oxytocin was administered multiple times. Socio-behavioral measures were improved in 3 out of 5 studies in which oxytocin was administered multiple times. In 2 studies in which prolonged exposure treatment and nasal oxytocin administration were combined for 10 weeks, patient symptoms were decreased compared to the control group. @*Conclusion@#The possibility of oxytocin as an adjuvant treatment for PTSD psychotherapy was confirmed. Further studies are necessary to evaluate the long term effectiveness of administering oxytocin multiple times combined with psychotherapy.

Trends in Brain Imaging Research on Refugees with Post-Traumatic Stress Disorder: A Scoping Review

Purpose@#The purpose of this study was to analyze research trends and find whether Post-Traumatic Stress Disorder (PTSD) of refugees could affect structural or functional changes of brains of those under MRI, focusing on volumes, functional connectivities, and metabolites. @*Methods@#A literature search was done using PubMed, Embase, RISS, and KMBase to identify studies that matched our research purpose. A total of eight studies were identified using Prisma flow diagram by two reviewers independently. @*Results@#Eight studies were identified. Three studies were on North Korean defectors as subjects. The number of studies that observed structural changes, functional changes, and metabolite changes in brains was 2, 5, and 2, respectively. Although each study observed various parts of the brain, anterior cingulate cortex (ACC) was observed commonly in three studies. The PTSD group showed reduction of ACC volume and N-acetyl-aspartate (NAA) metabolite in ACC compared to the non- PTSD group. When exposed to negative stimuli, the PTSD group showed higher neural activity than the non-PTSD group, but not vice versa. @*Conclusion@#ACC showed significant difference in volume, neural activity, and NAA metabolite between the PTSD and the non-PTSD group, resulting in significant differences in structural changes, functional changes, metabolite changes, respectively. This study showed the need for conducting more research using various biomarkers to clarify the relationship between PTSD of refugees and their brain changes.

Trends in Brain Imaging Research on Refugees with Post-Traumatic Stress Disorder: A Scoping Review

Purpose@#The purpose of this study was to analyze research trends and find whether Post-Traumatic Stress Disorder (PTSD) of refugees could affect structural or functional changes of brains of those under MRI, focusing on volumes, functional connectivities, and metabolites. @*Methods@#A literature search was done using PubMed, Embase, RISS, and KMBase to identify studies that matched our research purpose. A total of eight studies were identified using Prisma flow diagram by two reviewers independently. @*Results@#Eight studies were identified. Three studies were on North Korean defectors as subjects. The number of studies that observed structural changes, functional changes, and metabolite changes in brains was 2, 5, and 2, respectively. Although each study observed various parts of the brain, anterior cingulate cortex (ACC) was observed commonly in three studies. The PTSD group showed reduction of ACC volume and N-acetyl-aspartate (NAA) metabolite in ACC compared to the non- PTSD group. When exposed to negative stimuli, the PTSD group showed higher neural activity than the non-PTSD group, but not vice versa. @*Conclusion@#ACC showed significant difference in volume, neural activity, and NAA metabolite between the PTSD and the non-PTSD group, resulting in significant differences in structural changes, functional changes, metabolite changes, respectively. This study showed the need for conducting more research using various biomarkers to clarify the relationship between PTSD of refugees and their brain changes.

Factors Affecting Quality of Life in Patients with Unruptured Intracranial Aneurysm: A Systematic Review / 기본간호학회지

Purpose@#The purpose of this study was to comprehensively explore factors affecting quality of life in patients with unruptured intracranial aneurysm (UIA). @*Methods@#This study was conducted base on the National Evidence-based Healthcare Collaborating Agency (NECA) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). To search studies related to quality of life in patients with UIA. KoreaMed, Kmbase, Kiss, Pubmed, EMBASE, Cochrane Central and CINAHL were used. Key words were 'unruptured intracranial aneurysm', 'quality of life' and 'well-being'. A total of 136 studies were identified. After confirming duplication and abstracts, 15 studies were selected for analysis. @*Results@#As a result, factors affecting the quality of life in patients with UIA were categorized into individual factors, disease related factors, symptom related factors, and functional related factors. The Short form-36 was one of the most frequently used measurements. @*Conclusion@#To improve the quality of life of patients with UIA, researchers need to explore the multiple factors affecting quality of life in patients with UIA, and consider application of tools that can reflect the disease specific quality of life in patients with UIA.

Importance-Performance Analysis (IPA) to Improve Emergency Care for Novice Nurses / 기본간호학회지

PURPOSE: Although emergency care is one of the most important capabilities for novice nurses, many novice nurses have shown difficulty in emergency care in the clinical field. The purpose of this study was to provide evidence data for the future development of educational programs by analyzing the priorities in emergency care of novice nurses using the Importance-Performance Analysis. METHODS: This study was designed as a descriptive survey. The participants were 197 novice nurses who worked in general hospitals from August 1 to 31, 2018. The questionnaire consisted of ‘common emergency care’, ‘cardiovascular emergency care’, ‘nervous system emergency care’, ‘respiratory system emergency care’, ‘communication and teamwork competency’. RESULTS: As a result of this study, ‘communication and teamwork’ among emergency cares was evaluated as the most important capability in the clinical field. In the Importance-Performance Analysis, a total of 12 items were included in the quadrant A, including 5 items related to ‘cardiovascular emergency care’, 4 items to ‘respiratory system emergency care’, 2 items to ‘nervous system emergency care’ and 1 item to ‘common emergency care’. The results showed a need for intensive improvement in items included in quadrant A which are the high importance low performance items. CONCLUSION: In order to improve the emergency care of novice nurses, a variety of emergency care education programs on the nervous system and respiratory system care should be implemented as well as cardiovascular emergency care education.

Oxaliplatin-induced Peripheral Neuropathy, Symptoms, Distress and Quality of Life among Korean Patients with Gastrointestinal Cancer

PURPOSE: This study was conducted to identify the level of oxaliplatin-induced peripheral neuropathy (OIPN), symptoms, distress, and quality of life (QoL) in gastrointestinal (GI) cancer patients and to identify the factors influencing QoL.METHODS: A total of 123 patients were recruited for this cross-sectional study. Surveys used were the Therapy-Induced Neuropathy Assessment Scale (TNAS) for OIPN, the MD Anderson Symptom Inventory (MDASI-GI) for general symptoms associated with gastrointestinal cancer and its treatment, a distress thermometer, and the Euro Quality of Life Questionnaire 5-Dimensional Classification (EQ-5D) for QoL.RESULTS: The patients were classified into three groups based on their treatment completion time (current, completed less than one year ago, completed more than one year ago). The scores of MDASI-GI and distress were significantly lower in patients who had completed chemotherapy compared to those who were undergoing treatment (p=.04 and .02 respectively). However, TNAS score was significantly higher in patients who completed chemotherapy less than one year ago than the other two groups (p=.001). In multivariate regression models, the OIPN and distress or general symptoms were identified as factors associated with QoL.CONCLUSION: In this study, we identified the symptoms that are factors related to the QoL in patients with GI cancer. In particular, the symptoms of OIPN are reported at significantly increased levels for patients who have finished chemotherapy less than one year ago, so efforts to prevent and manage the symptoms of OIPN are needed in this timeframe. To improve QoL of patients with GI cancer, continuous attention and care are required not only during the treatment of cancer but also after the completion of treatment.

Factors Affecting Postoperative Occupational Changes and Sick Leave in Patients with Thyroid Cancer

BACKGROUND AND OBJECTIVES: Most thyroid cancers progress slowly, have high survival rates, and have good prognosis. Therefore, the management of patients with thyroid cancer should be viewed from a long-term perspective, taking into account a return to normal social life. Cancer patients have a higher risk of unemployment than the general population, and so unemployment can be an economic problem for thyroid cancer patients. However, there have been few studies on factors affecting return to work in thyroid cancer patients. The purpose of this study is to investigate occupational changes and the period of leave of absence for patients with thyroid cancer and to identify factors that affect the return to work after surgery.MATERIALS AND METHODS: A total of 427 questionnaires of thyroid cancer patients were used for the analysis. The occupational changes and sick leave periods were analyzed according to general characteristics, disease-related characteristics, and side effects.RESULTS: The factors related to occupational change and leave of absence in thyroid cancer patients were sex and type of occupation. Women had more occupational changes and longer leave of absence than men, office workers had the least change in occupation, and professional workers had a longer period of sick leave. Fatigue was the primary side effect that affected the leave of absence.CONCLUSION: Occupation is very important in the life of a thyroid cancer patient. Informing the patient of possible complications and planning proper leave of absence will help the patient return to work and improve the quality of life.

Current Pharmacogenetic Approach for Oxaliplatin-induced Peripheral Neuropathy among Patients with Colorectal Cancer: A Systematic Review

PURPOSE: Peripheral neuropathy is common among colorectal cancer (CRC) patients who undergo oxaliplatin-based (OXL) chemotherapy. A pharmacogenetic approach can be used to identify patients at high-risk of developing severe neuropathy. This type of approach can also help clinicians determine the best treatment option and prevent severe neurotoxicity. The purpose of this study is to investigate the evidence of pharmacogenetic markers for OXL-induced peripheral neuropathy (OXIPN) in patients with CRC. METHODS: A systematic literature search was conducted using the following databases up to December 2017: Pubmed, EMBASE, and CINAHL. We reviewed the genetic risk factors for OXIPN in observational studies and randomized controlled clinical trials (RCTs). All processes were performed independently by two reviewers. RESULTS: Sixteen studies published in English between 2006 and 2017 were included in this review. A genome-wide association approach was used in one study and various candidate genes were tested, based on their functions (e.g., DNA damage or repair, ion channels, anti-oxidants, and nerve growth etc.). The genes associated with incidence or severity of OXIPN were ABCG2, GSTP1, XRCC1, TAC1, and ERCC1. CONCLUSION: This study highlighted the need and the importance of conducting pharmacogenetic studies to generate evidence of personalized OXIPN symptoms management. Additional studies are warranted to accelerate the tailored interventions used for OXIPN in patients with CRC (NRF-2014R1A1A3054386).

Snoring as a Risk Factor of Fall in the Community Elderly

OBJECTIVE: Fall is one of major causes of morbidity and mortality in the elderly. It is known that sleep is associated with quality of life in the elderly. Snoring is one of the factors affecting sleep quality. The aim of the study was to examine whether snoring affect fall in the community elderly. METHODS: This survey was performed as a part of the Korean Social Life, Health, and Aging Project, which studied the elderly living in Ganghwa-gun. Fall was defined as any history of fall in the last year through face-to-face interview. We examined the following variables: age, sex, snoring, insomnia, hypertension, diabetes, stroke, bone disease, vision problems, depression, alcohol intake, mini-mental state examination, and body mass index. The data was analyzed by multiple logistic regression to determine the association of fall with the risk factors. RESULTS: In the multivariate analysis of 516 participants, the adjusted odd ratios (95% confidence interval) of simple snoring affecting fall was 1.70 (1.10–2.63). In addition, sex (female), age, and diabetes were significantly predicted the fall. CONCLUSION: Our result suggested that snoring could be a risk factor of fall. A more comprehensive study of the relationship between snoring and fall is needed to improve the quality of life of the community elderly.

Interprofessional Education Programs for Nursing Students: A Systematic Review / 한국간호교육학회지

PURPOSE: The purpose of this study was to investigate how interprofessional education has been designed, implemented, and evaluated in undergraduate programs in nursing through a systematic review. METHODS: The literature was searched using the PubMed, CINAHL, EMBASE, and Cochrane central databases to identify interventional studies including teaching-learning activities among nursing students and other disciplines in English between January 2000 and May 2017. Thirty studies were selected for the analysis. RESULTS: Twenty-four studies out of 30 were designed as a pre-post, no control group, quasi-experimental study design. Interprofessional education learners were primarily engaged in medicine, physical therapy, dentistry, occupational therapy, pharmacy, and respiratory therapy. Patient care related activity was the most frequently selected topic and simulation was the most common teaching-learning method. Evaluation of learning outcomes was mainly based on the aspects of teams and collaboration, professional identity, roles and responsibilities, patient care, and communication skills. Nursing students in 26 out of the 30 reviewed studies were found to benefit from interprofessional education, with outcome effects primarily related to changes in learning outcomes. CONCLUSION: The development and integration of interprofessional education with collaborative practices may offer opportunities in nursing education for training professional nurses of the future.

Factors Associated with Insomnia among the Elderly in a Korean Rural Community

OBJECTIVE: Sleep disturbance is common in the elderly, which is result from multi-factorial causes encompassing socio-demographic, behavioral, and clinical factors. We aimed to identify factors associated with insomnia among the elderly in a rural community in South Korea, a country with a rapidly growing aged population. METHODS: This cross-sectional study used the data from the second wave of the Korean Social life, Health and Ageing Project, which is a cohort study of individuals living in a typical rural community in South Korea. Socio-demographic, behavioral, and clinical characteristics were obtained through face-to-face interviews. Various factors suspected to be associated with insomnia were compared between elderly participants with and without insomnia, and multiple logistic regression analyses were conducted to identify independent risk factors for insomnia. RESULTS: We found that 32.4% of 509 participants (72.8±7.7 years old) had insomnia. Female sex [odds ratio (OR)=2.19], low education level (OR=2.44), current smoking (OR=2.26), number of chronic diseases (OR=2.21 for 2–3 chronic diseases; OR=2.06 for 4 or more chronic diseases), and depression (OR=2.53) were independently associated with insomnia. CONCLUSION: We found that sex, education, chronic disease, and depression independently increase the risk of insomnia of the elderly in a Korean rural community. To overcome the elderly's insomnia, interventions should target modifiable factors such as depression. To promote active aging, longitudinal studies of factors associated with insomnia among the elderly should be performed in different regions and communities.

Evidence-Based Clinical Practice Guideline for Fluid Therapy to Prevent Contrast-induced Nephropathy / 임상간호연구

PURPOSE: This study was to develop evidence-based clinical practice guideline in order to prevent contrast-induced nephropathy (CIN) for patients undergoing percutaneous coronary intervention (PCI). METHODS: The guideline was developed based on the “Scottish Intercollegiate Guidelines Network (SIGN)”. The first draft of guideline was developed through 5 stages and evaluated by 10 experts.(1) Clinical questions were ensured in PICO format.(2) Two researchers conducted a systematic search through electronic database, identifying 170 studies. We selected 27 full text articles including 16 randomized clinical trials, 7 systematic reviews, and 4 guidelines. Quality of each studies were evaluated by the Cochran's Risk of Bias, AMSTAR, K-AGREEII. Among the studies, 11 studies were excluded.(3) The strength of recommendations were classified and quality of recommendations were ranked.(4) Guideline draft was finalized.(5) Content-validation was conducted by an expert group. All contents were ranked above 0.8 in CVI. RESULTS: Evidence-based clinical practice guideline to prevent CIN was dveloped.(1) The guideline for preventing CIN recommends using 0.9% saline.(2) Standardized rate of fluid therapy is 1 to 1.5ml/kg/hr.(3) Execute hydration for 6~12hrs before PCI and after PCI. CONCLUSION: This study suggests evidence-based clinical practice guideline for preventing CIN which can be more efficiently used in clinical practice.

Factors Influencing Health Promoting Behavior among Peripheral Arterial Disease Patients

BACKGROUND: The purpose of this study was to examine illness perception, knowledge about the disease and health promoting behaviors, and to identify factors influencing health promoting behaviors among Peripheral Arterial Disease (PAD) patients. METHODS: The participants were 128 PAD patients who had been treated as an outpatient or an inpatient at the department of cardiology in a tertiary hospital in Seoul, Korea. Data were collected from October to December 2014, regarding general characteristics, disease related characteristics, illness perception and knowledge on PAD, health promoting behaviors by using a structured questionnaire. RESULTS: The number of subjects who had an awareness of PAD diagnosis was 70 (54.7%) among 128. In this study, knowledge on PAD was significantly correlated with health promoting behaviors (r=0.205, P=0.020). Especially, knowledge on PAD had a significant correlation with health responsibility (r=0.353, P<0.001) and exercise (r=0.230, P=0.009). In the regression analysis, knowledge on PAD was a factor that influences the health promoting behavior in this study subjects (R2=0.212, P=0.032). CONCLUSIONS: We could determine the degree of perception, knowledge, and health promoting behaviors among participants and the influence of PAD-related knowledge on health promoting behaviors. Conclusively, the results of this study support the development of education intervention to ameliorate disease perception and PAD related knowledge in order to improve health promoting behaviors among PAD patients.

Factors Associated with Obstructive Sleep Apnea Risk in Patients with Metabolic Syndrome

PURPOSE: This study was conducted to identify the factors associated with obstructive sleep apnea (OSA) risk in patients with metabolic syndrome (MS). METHODS: Patients with MS between 30 and 74 years of age were recruited in an outpatient clinic of a cardiovascular center in Seoul, South Korea. MS and the risk of OSA were evaluated by Berlin questionnaire survey, the medical records of the participants were reviewed and a comprehensive lifestyle survey was performed. SPSS WIN 21.0 was used for statistical analysis. RESULTS: BMI (OR: 1.31, CI: 1.14-1.51, p<.001) and lifestyle score (OR: 0.96, CI: 0.93-0.99, p=.028) were associated with the risk of OSA. Physical activity, weight control and diet were specifically associated with the risk of OSA after controlling for age, gender and BMI. CONCLUSION: This study demonstrated that lifestyle was an important factor associated with OSA risk in patients with MS.

Current Interventions to Improve Adherence to Immunosuppressants in Liver Transplant Recipients: a Systematic Review

PURPOSE: Adherence to immunosuppressants is the key to prevent organ rejection in organ transplant recipients. The purpose of this study was to investigate current interventions to improve adherence to immunosuppressants in liver transplant recipients. METHODS: A systemic literature search was done using PubMed, Embase, Cochrane Library, CINAHL and four Korean databases to identify experimental studies reported in English or Korean up to and including 2015. We identified eight intervention studies on the adherence to immunosuppressants in liver transplant recipients independently reviewed by two reviewers. The quality and risk of bias of the selected studies were assessed. RESULTS: Education, conversion of regimen, and text messaging were identified as intervention techniques to improve adherence. We found positive results in three out of four studies implementing educational strategies, but the results were not sufficient to draw a definite conclusion. Conversion from a twice-daily tacrolimus-based regimen to a once-daily tacrolimus extended-release formula was used in three adult-only studies and its effectiveness was confirmed. One study showed that improved adherence and outcomes were effected by using text messaging with pediatric patients. CONCLUSION: Future research is needed to facilitate interventions to improve adherence to immunosuppressants in various ages of patients including pediatric/adolescent liver transplant recipients.

Gender Differences in Hypertension Control Among Older Korean Adults: Korean Social Life, Health, and Aging Project / 예방의학회지

OBJECTIVES: Controlling blood pressure is a key step in reducing cardiovascular mortality in older adults. Gender differences in patients' attitudes after disease diagnosis and their management of the disease have been identified. However, it is unclear whether gender differences exist in hypertension management among older adults. We hypothesized that gender differences would exist among factors associated with hypertension diagnosis and control among community-dwelling, older adults. METHODS: This cross-sectional study analyzed data from 653 Koreans aged > or =60 years who participated in the Korean Social Life, Health, and Aging Project. Multiple logistic regression was used to compare several variables between undiagnosed and diagnosed hypertension, and between uncontrolled and controlled hypertension. RESULTS: Diabetes was more prevalent in men and women who had uncontrolled hypertension than those with controlled hypertension or undiagnosed hypertension. High body mass index was significantly associated with uncontrolled hypertension only in men. Multiple logistic regression analysis indicated that in women, awareness of one's blood pressure level (odds ratio [OR], 2.86; p=0.003) and the number of blood pressure checkups over the previous year (OR, 1.06; p=0.011) might influence the likelihood of being diagnosed with hypertension. More highly educated women were more likely to have controlled hypertension than non-educated women (OR, 5.23; p=0.013). CONCLUSIONS: This study suggests that gender differences exist among factors associated with hypertension diagnosis and control in the study population of community-dwelling, older adults. Education-based health promotion strategies for hypertension control might be more effective in elderly women than in elderly men. Gender-specific approaches may be required to effectively control hypertension among older adults.

Psychometric Properties of the Korean Version of the HIV Self-Management Scale in Patients with HIV

PURPOSE: The purpose of this study was to examine validity and reliability of Webel and colleagues' HIV Self-Management Scale when used with a Korean sample. METHODS: The original 20-item HIV Self-Management Scale was translated into Korean using translation and back-translation. Nine HIV nurse experts tested content validity. Principal component analysis (PCA) and confirmatory factor analysis (CFA) of data from 203 patients was used to test construct validity. Concurrent validity was evaluated using correlation with patients' self-rating as a "smart patient" measured using a visual analogue scale. Internal consistency was tested by Cronbach's alpha coefficients. RESULTS: All items were rated as having satisfactory content validity. Based on PCA and consideration of conceptual meaning, a three-factor solution was selected, explaining 48.76% of the variance. CFA demonstrated the adequacy of the three-domain structure of the construct HIV self-management: daily self-management health practices, social support and HIV self-management, and chronic nature of HIV self-management. Goodness-of-fit indices showed an acceptable fit overall with the full model (chi2/ df(164)=1.66, RMSEA=0.06, SRMR=0.05, TLI=0.91, and CFI=0.92). The Korean version of the HIV Self-Management Scale (KHSMS) was significantly correlated with patients' self-rated smart patient (r=.41). The subscale Cronbach's alpha coefficients ranged from .78 to .81; alpha for the total scale was .89. CONCLUSION: The KHSMS provides a valid and reliable measure of self-management in Korean patients with HIV. Continued psychometric testing is recommended to provide further evidence of validity with this population.

Appendicular Skeletal Muscle Mass and Insulin Resistance in an Elderly Korean Population: The Korean Social Life, Health and Aging Project-Health Examination Cohort

BACKGROUND: Increasing evidence supports an association between age-related loss of muscle mass and insulin resistance. However, the association has not been fully investigated in the general population. Thus, we investigated the association between appendicular skeletal muscle mass (ASM) and insulin resistance in an elderly Korean population. METHODS: This cross-sectional study included 158 men (mean age, 71.8) and 241 women (mean age, 70.6) from the Korean Social Life, Health and Aging Project, which started in 2011. In this study, ASM was measured by bioelectrical impedance analysis and was analyzed in three forms: ASM (kg), ASM/height2 (kg/m2), and ASM/weight (%). The homeostasis model assessment of insulin resistance (HOMA-IR) was used as a measure of insulin resistance. The relationships between the ASM values and the HOMA-IR were investigated by multiple linear regression models. RESULTS: The HOMA-IR was positively associated with ASM (beta=0.43, P<0.0001) and ASM/height2 (beta=0.36, P<0.0001) when adjusted for sex and age. However, after additional adjustment for body weight, HOMA-IR was inversely associated with ASM (beta=-0.43, P<0.001) and ASM/height2 (beta=-0.30, P=0.001). Adjustment for other potential confounders did not change these associations. Conversely, HOMA-IR was consistently and inversely associated with ASM/weight before and after adjustment for other potential confounders. CONCLUSION: Our results support the idea that lower skeletal muscle mass is independently associated with insulin resistance in older adults. When evaluating sarcopenia or muscle-related conditions in older adults, their whole body sizes also need to be considered.

Current Domestic Research Trends for Exercise Intervention for Patients with Breast Cancer Undergoing Chemotherapy or Radiotherapy

PURPOSE: Cardiotoxicity following cancer chemotherapy or radiotherapy is an emerging issue for breast cancer patients. The purpose of this study was to analyze the current domestic research trends for exercise intervention for Korean breast cancer patients under chemotherapy or radiotherapy, focused on cardiovascular indices as study outcome measures and to make suggestions for future nursing studies. METHODS: A literature search was done using PubMed, CINAHL and two Korean databases to identify experimental studies reported in Korean or English between 2,000 and 2015. We identified five studies independently reviewed by two reviewers. The quality and risk of bias of the selected studies were assessed by RoBANS criteria. RESULTS: Tai-chi exercise was used in three studies and aerobic exercise programs or yoga and walking exercise in the remaining studies. Two studies evaluated cardiovascular outcomes and showed positive findings for breast cancer patients. For cardiovascular indices, heart rate and blood pressure were used. CONCLUSION: This study showed the need for conducting well-designed experimental studies including clinical cardiovascular outcomes to generate evidence on exercise intervention for cancer therapy-induced cardiotoxicity prevention. Additional studies are warranted to accelerate the potential use of exercise as a nursing intervention for cancer patients under chemotherapy or radiotherapy.