Structural and functional characterization of the locus coeruleus in young and late middle-aged individuals.

Introduction: The brainstem locus coeruleus (LC) influences a broad range of brain processes, including cognition. The so-called LC contrast is an accepted marker of the integrity of the LC that consists of a local hyperintensity on specific Magnetic Resonance Imaging (MRI) structural images. The small size of the LC has, however, rendered its functional characterization difficult in humans, including in aging. A full characterization of the structural and functional characteristics of the LC in healthy young and late middle-aged individuals is needed to determine the potential roles of the LC in different medical conditions. Here, we wanted to determine whether the activation of the LC in a mismatch negativity task changes in aging and whether the LC functional response was associated to the LC contrast. Methods: We used Ultra-High Field (UHF) 7-Tesla functional MRI (fMRI) to record brain response during an auditory oddball task in 53 healthy volunteers, including 34 younger (age: 22.15y ± 3.27; 29 women) and 19 late middle-aged (age: 61.05y ± 5.3; 14 women) individuals. Results: Whole-brain analyses confirmed brain responses in the typical cortical and subcortical regions previously associated with mismatch negativity. When focusing on the brainstem, we found a significant response in the rostral part of the LC probability mask generated based on individual LC images. Although bilateral, the activation was more extensive in the left LC. Individual LC activity was not significantly different between young and late middle-aged individuals. Importantly, while the LC contrast was higher in older individuals, the functional response of the LC was not significantly associated with its contrast. Discussion: These findings may suggest that the age-related alterations of the LC structural integrity may not be related to changes in its functional response. The results further suggest that LC responses may remain stable in healthy individuals aged 20 to 70.

It is the locus coeruleus! Or is it?: a proposition for analyses and reporting standards for structural and functional magnetic resonance imaging of the noradrenergic locus coeruleus.

The noradrenergic locus coeruleus (LC) is one of the protein pathology epicenters in neurodegenerative diseases. In contrast to PET (positron emission tomography), MRI (magnetic resonance imaging) offers the spatial resolution necessary to investigate the 3-4 mm wide and 1.5 cm long LC. However, standard data postprocessing is often too spatially imprecise to allow investigating the structure and function of the LC at the group level. Our analysis pipeline uses a combination of existing toolboxes (SPM12, ANTs, FSL, FreeSurfer), and is tailored towards achieving suitable spatial precision in the brainstem area. Its effectiveness is demonstrated using 2 datasets comprising both younger and older adults. We also suggest quality assessment procedures which allow to quantify the spatial precision obtained. Spatial deviations below 2.5 mm in the LC area are achieved, which is superior to current standard approaches. Relevant for ageing and clinical researchers interested in brainstem imaging, we provide a tool for more reliable analyses of structural and functional LC imaging data which can be also adapted for investigating other nuclei of the brainstem.

Priorities for research on neuromodulatory subcortical systems in Alzheimer's disease: Position paper from the NSS PIA of ISTAART.

The neuromodulatory subcortical system (NSS) nuclei are critical hubs for survival, hedonic tone, and homeostasis. Tau-associated NSS degeneration occurs early in Alzheimer's disease (AD) pathogenesis, long before the emergence of pathognomonic memory dysfunction and cortical lesions. Accumulating evidence supports the role of NSS dysfunction and degeneration in the behavioral and neuropsychiatric manifestations featured early in AD. Experimental studies even suggest that AD-associated NSS degeneration drives brain neuroinflammatory status and contributes to disease progression, including the exacerbation of cortical lesions. Given the important pathophysiologic and etiologic roles that involve the NSS in early AD stages, there is an urgent need to expand our understanding of the mechanisms underlying NSS vulnerability and more precisely detail the clinical progression of NSS changes in AD. Here, the NSS Professional Interest Area of the International Society to Advance Alzheimer's Research and Treatment highlights knowledge gaps about NSS within AD and provides recommendations for priorities specific to clinical research, biomarker development, modeling, and intervention. HIGHLIGHTS: Neuromodulatory nuclei degenerate in early Alzheimer's disease pathological stages. Alzheimer's pathophysiology is exacerbated by neuromodulatory nuclei degeneration. Neuromodulatory nuclei degeneration drives neuropsychiatric symptoms in dementia. Biomarkers of neuromodulatory integrity would be value-creating for dementia care. Neuromodulatory nuclei present strategic prospects for disease-modifying therapies.

FDG-PET assessment of the locus coeruleus in Alzheimer's disease.

Sensitive and reliable in vivo imaging of the locus coeruleus (LC) is important to develop and evaluate its potential as a biomarker in neurodegenerative diseases such as Alzheimer's disease (AD). It is not known whether AD-related alterations in LC integrity can be detected using 18F-labelled fluoro-2-deoxyglucose (FDG) positron emission tomography (PET). Mean FDG-PET images from AD patients (N â€‹= â€‹193) and controls (N â€‹= â€‹256) from the ADNI database were co-registered to a study-wise anatomical template. Regional LC median standardized uptake value ratio (SUVR) values were obtained using four previously published LC masks and normalized to values from pons and cerebellar vermis reference regions. To support the validity of our methods, other regions previously reported to be most and least affected metabolically in AD were also compared to controls. The LC did not show between-group differences in FDG-PET signal, whereas the mammillary bodies did, despite these regions having comparable volumes and SUVR ranges. Brain regions previously reported to be most and least affected metabolically in AD compared to controls showed medium-to-large and small effect sizes for SUVR differences respectively. The results do not support the current application of LC FDG-PET signal as an in vivo biomarker for AD. Methodological and demographic factors potentially contributing to these findings are discussed. Future research may investigate age-related differences in LC FDG-PET signal and higher resolution images to fully explore its biomarker potential.

The role of academic-practice partnerships from perspectives of nursing students: A cross -sectional study.

BACKGROUND: Collaborations between nursing schools and teaching hospitals are important for achieving the goals of clinical nursing education. While previous work showed that nursing students benefit from academic-practice partnerships, it is unclear how these collaborations help nursing students. OBJECTIVE: To identify the role of academic-practice partnerships from the perspective of nursing students. Two hypothetical models based on system theory were proposed that utilized input-transformation-output processes. The input, transformation, and outputs were the "academic-practice partnership", "interaction between nurses and nursing students", and "professional self-concept and organizational socialization of nursing students", respectively. DESIGN: This study used a cross-sectional research design. SETTING: This study was conducted at a nursing school in Korea. PARTICIPANTS: The participants included 243 fourth-year nursing students who were about to graduate. METHODS: A questionnaire was used to collect data in August 2019. Path analysis was used to explore the models to determine the roles of academic-practice partnerships. RESULTS: Two hypothetical models indicated the role of academic-practice partnership. The academic-practice partnership positively affected the interaction between nurses and nursing students, which directly and indirectly benefitted professional self-concept and organizational socialization of nursing students. CONCLUSION: The higher perceived academic-practice partnership by nursing students, the better their interactions with nurses, professional self-concept, and organizational socialization. Therefore, nursing students should be aware of the academic-practice partnerships and nursing educators should effectively show these partnerships or collaborations to nursing students. Moreover, nursing educators should also encourage nursing students to interact with their preceptors in their practicums and, as nurses are important educators in academic-practice partnerships, they should be qualified as preceptors to teach nursing students.

The association between periodontitis and dyslipidemia according to smoking and harmful alcohol use in a representative sample of Korean adults.

OBJECTIVES: The aim of this study was to examine whether dyslipidemia is associated with periodontitis according to age, sex, smoking, and harmful alcohol use in a representative sample of Korean adults who participated in the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-3). MATERIALS AND METHODS: We examined 3987 subjects aged 19 to 79 years who participated in the KNHANES VI-3. Dyslipidemia was defined according to the definition proposed by the Korean Society of Lipidology and Atherosclerosis. The periodontal status of the patients was assessed using the community periodontal index. Multivariate logistic regression analysis was carried out and adjusted for sociodemographic variables, oral and general health behaviors, and oral health status. All analyses considered a complex sampling design, and multivariate analysis was performed in the age, sex, smoking, and harmful alcohol use subgroups. RESULTS: Multivariate logistic regression analysis revealed significant associations between periodontitis and dyslipidemia including hypertriglyceridemia and hypo-high-density lipoprotein (HDL) cholesterolemia. In the subgroup analysis, periodontitis was significantly associated with hypo-HDL cholesterolemia in subjects older than 40 years, males, heavy smokers, and hazardous and harmful alcohol users. Moreover, periodontitis was significantly associated with hypercholesterolemia in hazardous and harmful alcohol users. CONCLUSIONS: The prevalence of periodontitis (CPI 3, 20.7%; CPI 4, 9.0%) was 29.7% in Korea. Hyper-TG and hypo-HDL-C were associated with periodontitis in all subjects. In the subgroup analysis, the association of periodontitis with hyper-TC and pre-hyper-TC was further confirmed in harmful alcohol users and males, respectively. CLINICAL RELEVANCE: This study reaffirmed that periodontitis is associated with dyslipidemia, especially with hyper-TG and hypo-HDL-C. As the association of periodontitis with hypo-HDL-C, hyper-TC, and pre-hyper-TC was found differently in subgroups according to age, gender, smoking, and alcohol drinking, researchers need to consider effect modifiers in further studies on the association between periodontitis and dyslipidemia.

Hand motor functions on the presence of red fluorescent dental biofilm in older community-dwelling Koreans.

BACKGROUND: The Quantitative Light-induced Fluorescence-Digital (QLF-D) system visualizes old and mature dental biofilm as red fluorescence. Risk factors for poor oral hygiene have been identified, however, few studies have evaluated the relationship between mature dental biofilm and hand motor functions. This study aimed to investigate the effects of two important manual motor functions for object manipulation -handgrip strength and manual dexterity- on the presence of red fluorescent dental biofilm in older community-dwelling Koreans using QLF-D, an optical device that reveals dental biofilm. METHODS: This cross-sectional study included 70 Korean participants aged ≥65 years, all of whom completed questionnaires and were tested for handgrip strength and manual dexterity. In total, 840 dental surfaces were photographed using QLF-D, and ΔR20 values, which reflect mature dental biofilm accumulation, were calculated. The t-test was performed to analyze the differences in the ∆R20 values according to sociodemographic characteristics, health-related characteristics and hand motor functions, while multiple linear regression analysis was used to investigate the effects of hand motor functions on the ∆R20 values. RESULTS: Multivariate regression analysis revealed that handgrip strength (ß = -0.294) was the factor most strongly affecting mature dental biofilm accumulation (ΔR20), followed by tooth-brushing time (ß = -0.262) and manual dexterity (ß = -0.241). CONCLUSIONS: Reductions in handgrip strength and manual dexterity were independent risk factors for pathogenic dental biofilm accumulation. The results of this investigation suggest that programs designed to prevent the decline, as well as improve, handgrip strength and manual dexterity might improve the oral hygiene of older adults.

Patient safety competency and the new nursing care delivery model.

AIM: To identify the factors affecting nurses' patient safety competency under the new nursing care delivery model. BACKGROUND: In Korea, a new model was introduced in 2013 to ensure that nursing personnel provided inpatients with care without relying on guardians. After the launch of this service, there continue to be nurse-related patient safety incidents. METHODS: This is a descriptive study. Data from 132 general hospital nurses were collected during 15-24 February 2017 and analysed using hierarchical multiple regression. RESULTS: Participants' mean patient safety competency score was 3.82 (range 1-5). Clinical career (Pratt index = 47.3%), critical thinking disposition (30.4%), teamwork (24.1%) and critical thinking training experience (7.3%) were found to affect nurses' patient safety competency. CONCLUSION: Under the new model, new nurses showed a low level of patient safety competency. Clinical career most influenced patient safety competency. Enhanced critical thinking and teamwork training are needed to improve patient safety competency among nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders must consider qualitative staffing mix involving appropriate placement of experienced nurses as well as quantitative staffing level to provide patients with high-quality, safe care and to implement the new model successfully. Regular training on critical thinking and teamwork should be carried out.

The association between dyslipidemia, oral health behavior, and periodontal disease: The Korea National Health and Nutrition Examination Survey.

OBJECTIVES: This research aims to confirm the association between dyslipidemia, oral health behaviors, and periodontal disease according to age groups. METHOD AND MATERIALS: This cross-sectional study used collected data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2012 to 2015 with 17,004 adults. Complex samples logistic regression analysis confirmed the relevant factors of oral disease. RESULTS: Hypo high-density lipoprotein cholesterol (HDL-C) related to periodontal disease in two groups (under 40 and over 40 years old). In the over-40 age group, the level of low-density lipoprotein cholesterol (LDL-C) was associated with periodontal disease; toothbrushing frequency and usage of interdental hygiene products were associated with periodontal disease. CONCLUSIONS: Better HDL-C level in all age groups, management of LDL-C level, tooth-brushing at least twice a day, and additional use of interdental hygiene products in the over-40 age group were associated with better oral health. Thus, public and oral health professionals should emphasize the relationship according to age group during health care education and share relevant information.

[Effects of Silver-Care-Robot Program on Cognitive Function, Depression, and Activities of Daily Living for Institutionalized Elderly People].

PURPOSE: The purpose of this study was to identify the effects on cognitive function, depression, and activities of daily living of Silver-Care-Robot Program for institutionalized elders. METHODS: This study was a nonequivalent control group pretest-posttest design. The participants were 42 institutionalized elders (17 in the experimental group and 25 in the control group). The Silver-Care-Robot Program was provided as an intervention which was conducted twice a week for 5 weeks. The Silver-Care-Robot Program is an integrated entertainment program to help the mental, emotional, and physical health of elderly people. Pre-test was conducted on the two groups, and, in order to examine the effects of intervention, a post-test was conducted after 5 weeks. RESULTS: There were significant differences in cognitive function and ADL (activities of daily living) between two groups after the program. But the difference in depression in the institutionalized elders was not statistically significant between the two groups. CONCLUSION: The Silver-Care-Robot Program should be considered as a regular program for cognitive function and activities of daily living for institutionalized elders.

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.

[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.

[Comparison of the effects of an exercise program in non-obese and obese women].

PURPOSE: The purpose of this study was to compare the effects of an exercise program on physical fitness, obesity indices, and blood lipids in cases of non-obese and obese women. METHOD: Data was collected from May, 2006 to November, 2006 in a public health center. All Subjects(37 women) participated in an exercise program that consisted of Latin dance, muscular strength training, and dumbbell exercises. Thirty-seven women were divided into two groups(16 non-obese women and 21 obese women) by %body fat. After 8 weeks, the effects of treatment were compared between pre-test and post-test in each group. RESULTS: Physical fitness(abdominal muscle strength, muscle endurance, flexibility, agility, balance) was significantly different between the pre-test and post-test in the non-obese and obese group. Obesity indices(body weight, BMI) was significantly different in obese women after the 8-week exercise program. There was no decrease of blood lipids in either group. CONCLUSION: These findings indicate that an exercise program could be an effective nursing intervention to increase physical fitness in non-obese and obese women and to decrease obesity indices(body weight, BMI) in obese women.

[Factors effecting health promoting behaviors in middle-aged women].

PURPOSE: This study was to evaluate the casual relationship between the factors in the Pender's model and to explain health promoting behaviors among middle-aged women in order to facilitate nursing interventions for this population group. METHOD: 116 women between 40-60 years old living in Incheon were asked to complete a questionnaire about their health. The data was collected between March and November, 2003. The data was analyzed by descriptive statistics and the correctional analysis SPSSWIN 11.5 program. The LISREL 8.12 program was used to find the best fit model which explained a causal relationship of the variables. RESULTS: The climacteric symptoms of middle-aged women negatively correlated with health promoting behaviors. However, marital satisfaction positively correlated with health promoting behaviors. CONCLUSION: Marital satisfaction and climacteric symptoms had an effect on health promoting behaviors. Therefore, based on this study, we plan to develop a health education program to decrease climacteric symptoms and to promote marital satisfaction for health promotion.

[Factors on decision-making participation related to clinical experience difference].

PURPOSE: The purpose of this study was to investigate the relationship between decision-making factors(theoretical knowledge, expertise, empowerment, intuition) and participation in proportion to nurses's clinical experience. METHOD: Data was collected by quota sampling from July 10, 2001 to August 22, 2001 from 132 clinical nurses who work for 3 General hospitals. Data was analyzed using SPSSWIN 10.0 with crosstab, ANOVA, and stepwise multiple regression. RESULT: Expertise(F=34.347, p=.000), empowerment(F=29.316, p=.000), and participation(F=3.276, p=.041) were significantly different among 3 clinical experience groups. Clinical experience correlated with expertise(r=.551, p=.000) and empowerment(r=.492, p=.000), and Decision-making participation also correlated with expertise(r=.351, p=.000) and empowerment(r=.265, p=.002). Decision-making participation is effected by theoretical knowledge(under 3.00 yr clinical experience), expertise(3.01-5.00 yr), and empowerment(above 5.01 yr). CONCLUSION: These findings indicate that factors(theoretical knowledge, expertise, or empowerment) on decision-making participation varies as nurses's clinical experience differs. Therefore, decision-making needs bilateral agreement between staff nurses and nurse managers rather than the responsibility of one.

[The effects of Koryo Hand-Acupuncture on the patients with chronic low back pain].

PURPOSE: The purpose of this study was to identify the effects of Koryo Hand-Acupuncture on health status(pain, trunk flexion, IADL, depression) of patients with chronic low back pain. METHOD: This study used a quasi experimental pre-test and post-test design. Data were collected from December 1st, 2000 to December 20th, 2001. 63 chronic low back pain patients(35 experimental group, 28 control group) admitted to the Back-School and consented to this study. The experimental group participated in treatment : Koryo Hand-Acupuncture and AB-Bong. Two groups was homogeneity. After 4 weeks the effects of treatment on the health status was measured between experimental and control group. Data were analyzed using SPSSWIN 10.0 with crosstab, t-test, and paired t-test. RESULT: In the experimental group, pain(t=4.85, p=.000) and IADL difficulty(t=2.05, p=.045) was significantly lower than those in the control group. It makes no difference trunk flexion(t=-1.60, p=.114) and depression(t=1.50, p=.138) between experimental and control group. CONCLUSION: These findings indicate that Koryo-Hand Acupuncture is an effective method for reducing pain and IADL difficulty in patients with chronic low back pain, and is considered as a independent nursing intervention for chronic low back pain.