Effect of psychosocial factors on autonomic nervous system activity in patients with heart failure.

Autonomic imbalance predicts worse clinical outcomes in patients with heart failure (HF). Managing the variables affecting heart rate variability (HRV) might improve the clinical outcomes of patients with HF. This study aimed to investigate variables affecting HRV. We assessed autonomic nervous system activity (low-frequency [Lf], high-frequency [Hf], and Lf/Hf ratio) in 60 patients with HF, employing standard measures to capture short-term HRV. To estimate the independent effects of variables such as well-known cardiac risk factors and psychosocial conditions on HRV, multivariate analyses were conducted. For psychosocial variables, we assessed depression and quality of life in patients and their family caregivers. We also assessed the self-care behavior of patients and their caregivers' burden. Depression in family caregivers and self-care behavior of patients were independently associated with a decreased Hf (ß-coefficient = 0.309, P = .039 and ß-coefficient = -0.029, P = .047, respectively). Depression of family caregivers and self-care behavior of patients may affect HRV in patients with HF.

Effect of White Noise on Pain Response, Heart Rate, and Oxygen Saturation During Heel Puncture in Premature Infants: A Randomized Controlled Trial.

OBJECTIVE: This study aimed to investigate the effect of white noise on pain response, heart rate, and oxygen saturation during heel puncture in premature infants. METHODS: A randomized, controlled, pretest-posttest design was used. The participants were premature infants admitted to the neonatal intensive care unit of a university hospital in Gyeonggi Province. Sixty premature infants were assigned to either an experimental (n = 30) or control (n = 30) group. The experimental group was exposed to white noise during heel puncture, and the measured variables were pain response, heart rate, and oxygen saturation. The data were analyzed using the independent t test, chi-squared test, and analysis of covariance. RESULTS: Premature infants in the experimental group had a lower pain response and heart rate than the control group (F = 81.26, P < .01; F = 7.05, P = .01), and higher oxygen saturation than the control group (F = 4.76, P = .03). CONCLUSION: These results demonstrated that the white noise intervention is an effective nursing intervention to reduce the pain response and stabilize heart rate and oxygen saturation in premature infants during heel puncture.

Effects of a self-determination theory-based physical activity programme for postmenopausal women with rheumatoid arthritis: A randomized controlled trial.

AIMS: The study aimed to develop and evaluate the effects of a self-determination theory-based, nurse-led, physical activity programme for postmenopausal women with rheumatoid arthritis. METHODS: Between December 2019 and April 2020, this randomized controlled trial recruited 62 postmenopausal women with rheumatoid arthritis from a university-affiliated hospital in South Korea. The intervention group participated in a self-determination theory-based, nurse-led, physical activity programme that consisted of Tai Chi-based physical activity, a supportive psychosocial strategy, and interactive counselling for 16 weeks, and the control group continued to undergo their usual care. RESULTS: There were statistically significant group-by-time interactions in physical activity and perceived sarcopenia, which favoured the intervention group. Additionally, the intervention group showed significant improvements in the perceived therapeutic efficacy of physical activity, grip strength, walking speed, disease activity score, and health-related quality of life. CONCLUSIONS: The programme developed in this study can be an effective and feasible approach for postmenopausal women with rheumatoid arthritis in improving physical activity, selected osteosarcopenic outcomes, and health-related quality of life. Further research is required to investigate the long-term effects of this theory-based programme for postmenopausal women in diverse settings.

A Qualitative Study on the Self-Care Experiences of People with Heart Failure.

We aimed to explore in-depth experiences and emotions of people with heart failure within the context of self-care. A qualitative descriptive study was conducted using semi-structured interviews. Ten patients were recruited from an outpatient clinic at a university-affiliated hospital in South Korea between September and November 2019. Data were analyzed using a thematic content analysis approach. Participants were 68-86 years old, and 80% were men. Five themes of the self-care experiences of persons with heart failure were identified: "Suddenly diagnosed with heart failure," "Unpredictable symptoms and unprepared for self-care," "Dependent on caring family on a heartbreaking uphill," "Self-care efforts with apprehension," and "Continued self-care efforts with expert help." Programs to support self-care for people with heart failure are needed and should be developed by incorporating patients' needs and reflecting their uncertainty and vulnerability.

Heart Failure-Smart Life: a randomized controlled trial of a mobile app for self-management in patients with heart failure.

BACKGROUND: It is an important strategy for healthcare providers to support heart failure patients with comprehensive aspects of self-management. A practical alternative to a comprehensive and user-friendly self-management program for heart failure patients is needed. This study aimed to develop a mobile self-management app program for patients with heart failure and to identify the impact of the program. METHODS: We developed a mobile app, called Heart Failure-Smart Life. The app was to provide educational materials using a daily health check-up diary, Q & A, and 1:1 chat, considering individual users' convenience. An experimental study was employed using a randomized controlled trial to evaluate the effects of the program in patients with heart failure from July 2018 to June 2019. The experimental group (n = 36) participated in using the mobile app that provided feedback on their self-management and allowed monitoring of their daily health status by cardiac nurses for 3 months, and the control group (n = 38) continued to undergo their usual care. The differences in the physical, psychosocial, and behavioral factors between the two groups over time were analyzed using the analysis of covariance. RESULTS: After 3 months of intervention, significant differences between experimental and control groups were shown in the New York Heart Association functional class (p = 0.003) and cardiac diastolic function (p = 0.024). The improvements over time in the experimental group tended to be higher than those in the control group in considered variables. However, no changes in psychosocial and behavioral variables were observed between the groups over time. CONCLUSIONS: This study provides evidence that the mobile app program may provide benefits to its users, specifically improvements of symptom and cardiac diastolic function in patients with heart failure. Healthcare providers can effectively and practically guide and support patients with heart failure using comprehensive and convenient self-management tools such as smartphone apps.

A cross-sectional study of nursing students' eHealth literacy and COVID-19 preventive behaviours.

AIM: This study explored nursing students' eHealth literacy, lifestyle behaviours and COVID-19-related preventive behaviours and associated factors. DESIGN: A cross-sectional comparative correlational study. METHODS: Nursing students (n = 358) from a metropolitan area of South Korea were recruited for an online survey. The online questionnaire included: The eHealth Literacy Scale, the Health Promoting Lifestyle Profile-II and the COVID-19-related preventive behaviour scale. RESULTS: COVID-19-related preventive behaviours correlated positively with satisfaction with one's major, time spent seeking health information online, eHealth literacy and lifestyle behaviours. Significant factors affecting COVID-19-related preventive behaviours were the following: being female (ß = 0.194, p < .001), time spent seeking health information online (ß = 0.114, p = .002), eHealth literacy (ß = 0.167, p = .001) and lifestyle behaviours (ß = 0.266, p < .001). CONCLUSIONS: Findings highlight the need to strengthen searching behaviours to access accurate health information online and reinforce eHealth literacy and health-promoting lifestyle behaviours to improve COVID-19 preventive behaviours among nursing students.

Predictive Model for Quality of Life in Patients With Heart Failure.

BACKGROUND: Although many studies have been conducted to examine predictors of quality of life (QoL), little information exists on the real-world application of Rector's conceptual model for QoL related to heart failure (HF). OBJECTIVES: In this study, we aimed to examine a hypothetical model of QoL based on Rector's conceptual model for QoL in relation to HF and the existing literature on patients with HF. METHODS: Using a cross-sectional survey, 165 patients with HF were recruited from an outpatient clinic in Korea. Data were collected based on Rector's model constructs, such as cardiac function, symptoms, functional limitation, depression, distress, and QoL. Left ventricular ejection fraction for cardiac function was measured using echocardiography. RESULTS: Functional limitation, depression, and distress, but not symptoms, had a direct effect on QoL (all Ps < .001). Cardiac function and symptoms directly affected functional limitation (ß = 0.186, P = .004, and ß = -0.488, P = < .001, respectively), whereas cardiac function, symptoms, and depression affected QoL through functional limitation and distress. CONCLUSIONS: These results confirm that the Rector's model is suitable for predicting QoL in patients with HF. These findings have potential to guide and inform intervention programs designed to alleviate symptoms in patients with HF, enhance their physical functioning, and moderate their psychological distress with the ultimate goal of improving their QoL.

Factors affecting the quality of life of family caregivers of patients with heart failure: A cross-sectional study.

Heart failure is a chronic disease requiring lifetime self-management at home by patients, who often require additional support. However, the long-term nature of this self-management presents great challenges for both heart failure patients and their family caregivers. The role of family caregivers is critical, but little is known about the relationship between the burden, stress, depressive symptoms, and quality of life in the family caregivers of heart failure patients. We aimed to explore caregiver burden, stress, depressive symptoms, and quality of life in both patients with heart failure and their family caregivers and identify the factors associated with family caregivers' quality of life. The sample included 120 participants (60 heart failure patients and 60 corresponding family caregivers) from cardiovascular outpatient clinics at 2 university-affiliated hospitals in South Korea from September 2018 to July 2019. The mean ages of the heart failure patients and their caregivers were 72.72 (SD = 12.73) and 57.03 (SD = 13.42) years, respectively. Caregiver burden (r = -0.601, P < .001) and caregiver depressive symptoms (r = -0.535, P < .001) were negatively correlated with the caregivers' quality of life. The result of the hierarchical multiple regression analysis identified 3 significant factors related to the family caregivers' quality of life: caregiver's age (ß = -0.257, P = .012), caregiver burden (ß = -0.408, P = .002) and caregiver depressive symptoms (ß = -0.298, P = .018), with overall explanatory power of 47.5%. It is necessary to develop practical strategies to improve family caregivers' quality of life by alleviating their burden and depressive symptoms. Healthcare providers should be engaged with not only heart failure patients but also their family caregivers during the disease management process to improve patients' outcomes.

Effects of Maternal Adjustment Enhancement Program Using Mobile-Based Education for Chinese Immigrant Women in Korea: A Quasi-Experimental Study.

INTRODUCTION: This study aimed to develop a maternal adjustment program for Chinese immigrant primiparous women in Korea and to investigate its effectiveness. METHODOLOGY: Forty-five Chinese immigrant women with newborns were recruited and conveniently assigned into experimental and control groups. A maternal adjustment enhancement program was initiated to the experimental group using a mobile-based education regarding cultural intimacy for 4 weeks. RESULTS: In the follow-ups, the experimental group showed significantly higher knowledge of childcare and parenting efficacy. Both the experimental and control groups showed an improvement in social support and a decrease in childcare stress without between-group differences. DISCUSSION: The maternal adjustment enhancement program can be utilized as an effective approach to improve knowledge of childcare and reinforce parenting efficacy of Chinese immigrant women in Korea. Strategies to reduce language barrier and to provide education with culturally friendly manners should be utilized for successful transition to motherhood among immigrant mothers.

Prevalence and correlates of depression among South Korean older adults living in relative poverty.

This secondary analysis of the Tailored Health Visiting Service Program examined depression prevalence and associated factors among 1181 community-dwelling, South Korean older adults (range: 65 to 99 years) who live in relative poverty. Depression was assessed using the Geriatric Depression Scale short form. Generalized linear models with Poisson family and log link functions were employed to identify factors associated with depression. The overall depression prevalence was 46.3%, with most subjects mildly depressed. Better self-rated health and healthy activities were associated with lower depression prevalence, while having a disability was associated with higher prevalence. The factors identified in this study should be considered in community mental health interventions for older adults, especially those who experience economic disadvantage.

Association between self-management behaviour and quality of life in people with heart failure: a retrospective study.

BACKGROUND: The purpose of this study was to investigate the variables that significantly associated with the quality of life in people with heart failure, and particularly, to identify the association between self-management behaviour and the quality of life. METHODS: This retrospective study used data from heart failure outpatient clinics at two large tertiary medical centres in Seoul and Suwon, South Korea. We enrolled 119 participants who completed echocardiography and stress tests and responded to questionnaires on self-management behaviour and quality of life. We collected more data on sociodemographic and clinical characteristics and anthropometric and serum blood test results through electronic medical record review. We analysed data using multiple linear regression and the classification and regression tree (CART) method to explore the associated factors with the quality of life in participants with heart failure. RESULTS: Participants' mean age was 74.61 years, and women represented 52.1% of the sample. It showed that cardiac systolic function (ß = 0.26, p = .013) and self-management behaviour (ß = 0.20, p = .048) were two major associated factors with the quality of life in participants with heart failure in the multiple linear regression analysis. Also, cardiac systolic function and self-management behaviour were shown to be the primary determinants for the quality of life in those with heart failure in the CART analysis. Therefore, self-management behaviour of the participants with heart failure was a significant modifiable factor that can improve their quality of life. CONCLUSIONS: Healthcare providers should be aware of the importance of self-management in people with heart failure and help promote their quality of life by enhancing their self-management behaviour as own efforts to properly maintain and monitor the health status and prevent further worsening of heart failure.

Association between self-reported physical activity and indicators of cardiovascular risk in community-dwelling older adults with hypertension in Korea: A cohort study.

ABSTRACT: The prevalence of hypertension has increased with the rise in the elderly population, and high blood pressure is a major cause of cardiovascular disease. Physical activity is an important strategy for preventing cardiovascular disease. The study aimed to explore the association between physical activity and cardiovascular risk indicators in community-dwelling older adults with hypertension.This study is a secondary data analysis of a prospective longitudinal study using data from the Elderly Cohort Database of the National Health Insurance Service in South Korea between 2002 and 2013. Participants included 10,588 older adults (≥60 years) with hypertension. Data assessing self-reported physical activity and directly measured blood pressure, fasting blood glucose, body mass index, and total cholesterol levels throughout the 12-year study were extracted from the original database and analyzed. Participants were categorized into 4 groups based on the reported changes in physical activity over time: Group I (Maintaining No Physical Activity Group), II (Changing from No Physical Activity to Physical Activity Group), III (Changing from Physical Activity to No Physical Activity Group), and IV (Maintaining Physical Activity Group). Cox proportional hazard model was used to confirm the risk of cardiovascular indicators over time in each group.Participants' mean age was 64.2 years in the initial year of 2002. The number of participants in Groups I, II, III, and IV was 4032, 2697, 1919, and 1940, respectively. Group IV showed a significant decline in risk for uncontrolled hypertension compared to Group I (hazard ratio = 0.87, 95% confidence interval [0.800-0.948]). Group II showed a significant decrease in risk for uncontrolled diabetes compared to Group I (hazard ratio = 0.94, 95% confidence interval [0.888-0.999]).The findings indicated that physical activity is a significant factor associated with indicators of cardiovascular risk in older people with high blood pressure. Healthcare providers should be aware of the importance of older adults' physical activity and encourage them to perform and maintain it steadily for better long-term cardio-metabolic outcomes.

Maternal adaptation of working mothers with infants or toddlers in South Korea: a systematic review.

BACKGROUND: The fertility rate in South Korea has been decreasing dramatically, as working women postpone or avoid childbirth due to the challenges of maintaining a career while raising a family. Working mothers with infants or toddlers have unique maternal adaptation needs, which must be understood in order to support their needs during childbearing years. Supporting successful maternal adaptation of working mothers is not only essential for each individual new working mother, but also benefits her family, her workplace, and the country. METHODS: A systematic review was conducted to describe the current state of the science on maternal adaptation of working mothers with infants or toddlers in South Korea. Eligible studies, published between 2009 and 2018, were identified by searching electronic databases. Quantitative studies related to the maternal adaptation of Korean working mothers who had a child younger than age 3 years were included. 37 articles met the inclusion criteria for narrative analysis and synthesis. RESULTS: Studies were classified into 4 major groups by maternal adaptation categories as psychological, behavioral, relational, and cognitive adaptation. The majority of studies were focused on working mothers' psychological adaptation (n = 36, 97.3%), followed by behavioral (n = 10, 27.0%), relational (n = 9, 24.3%), and cognitive (n = 3, 8.1%) adaptation. We found that maternal adaptation of working mothers was ultimately influenced by diverse variables within their communities, spousal and familial support, personal attributes, and job-related characteristics. CONCLUSIONS: These findings demonstrate the importance of understanding variable aspects of maternal adaptation of working mothers with infants or toddlers. The complexity of working mothers' needs at the individual, family, and community levels must be considered in order to develop effective intervention programs and public policy for supporting maternal adaptation in Korea.

Experiences of Mothers Facing the Prognosis of Their Children with Complex Congenital Heart Disease.

Mothers of children with complex congenital heart disease face unique challenges and emotional burdens, while their children go through physical and psychological difficulties during disease progression. In this study, we aimed to explore the in-depth experiences and feelings of mothers facing the prognosis of their children with complex congenital heart disease that was surgically corrected. This is a descriptive qualitative study. We conducted semi-structured, face-to-face interviews with 12 mothers of children with complex congenital heart disease at a tertiary hospital in Seoul, Korea. The interview data were analyzed by content analysis. Participants were mothers aged between 40-58 years whose children were diagnosed with complex congenital heart disease which was surgically corrected. Based on the content analysis, the mothers' experiences and feelings were categorized as immense suffering and adapting to a new life. Under the main categories, the concepts included feeling of abandonment, anxiety with potentially losing their children, having hope, seeking reassurance, being encouraged, and trying to embrace the situation. Mothers who cared for their children with complex congenital heart disease expressed emotions that changed sequentially alongside physical and psychosocial changes in the children. The results of this study are valuable for understanding the experiences and emotions of mothers facing the prognosis of their children with complex congenital heart disease in order to aid in the development of programs that support these mothers.

Comparison of learning needs priorities between healthcare providers and patients with heart failure.

It is necessary to understand the learning needs of heart failure (HF) patients to provide adequate patient education. It is necessary to identify what HF patients want to know and how this differs from the educational needs of healthcare providers. The aim of this descriptive and exploratory study was to evaluate and compare the learning needs priorities between HF patients and their healthcare providers. One hundred patients with HF and 20 healthcare providers were recruited from cardiovascular outpatient clinics at 2 large tertiary medical centers in South Korea. Learning needs were measured using a self-administered questionnaire with the Heart Failure Patients' Learning Needs Inventory. Data were analyzed using SPSS 23.0 program. Overall rank orders for 48 items were similar in both groups (Spearman rank order correlation 0.605, p < .001). The educational topics of medications and worsening signs and symptoms ranked highest in both groups. However, healthcare providers were more concerned with diet management than were the patients (mean score 4.18 vs. 3.62; p = .001). The study showed both similarities and differences between the assessments of the patients and healthcare providers of detailed educational learning needs. It is important to develop patient-centered educational materials considering HF patients' actual learning needs, and also to provide comprehensive and practical patient education based on a supportive understanding of healthcare provider needs.

[Effects of uncertainty and spousal support on infertility-related quality of life in women undergoing assisted reproductive technologies]. / ë³´ì¡°ìƒì‹ìˆ ì„ 받는 여성의 불확실성과 배우자 지지가 난임 ê´€ë ¨ 삶의 질에 미치는 영향.

Purpose: The purpose of this study was to investigate the effects of uncertainty and spousal support on infertility-related quality of life (QoL) in women undergoing assisted reproductive technologies. Methods: In this correlational survey study, 172 infertile women undergoing assisted reproductive technologies for infertility treatment at M hospital in Seoul participated. Data collection took place at the outpatient department of M hospital using a self-report questionnaire from July to August 2019. Data were analyzed using SPSS for Windows version 28.0. Results: The mean scores for uncertainty, spousal support, and infertility-related quality of life (QoL) were 28.35 (out of 50), 86.67 (out of 115), and 57.98 (out of 100), respectively. Infertility-related quality of life (QoL) was positively correlated with spousal support and negatively correlated with uncertainty. According to the regression analysis, infertility-related quality of life (QoL) was significantly affected by uncertainty, total number of assisted reproductive technology treatments, marriage duration, subjective health status, the financial burden of infertility testing, and the presence of a burdensome person. These variables had an explanatory power of 35.0% for infertility-related quality of life (QoL). Conclusion: Uncertainty was an important factor influencing infertility-related quality of life (QoL) among women undergoing assisted reproductive technologies. It is necessary to develop and implement a nursing intervention program focused on reducing various forms of uncertainty during assisted reproductive procedures and to consider other factors affecting infertility-related quality of life (QoL) in the clinical setting.

[Effects of stress, depression, and spousal and familial support on maternal identity in pregnant women]. / 임부의 ìŠ¤íŠ¸ë ˆìŠ¤, 우울 및 배우자와 가족의 지지가 모성 ì •ì²´ì„±ì— 미치는 영향.

Purpose: The objective of this study was to identify the factors influencing maternal identity in pregnant women. Methods: Using a descriptive research design, a cross-sectional survey was conducted. In total, 127 pregnant women were recruited from a tertiary hospital in Korea from January to April 2019. Measurements included maternal identity, stress, depression, spousal and familial support, and demographic and obstetric characteristics. Data were analyzed by descriptive statistics, the independent t-test, one-way ANOVA, Pearson correlation coefficients, and stepwise multiple regression using SPSS version 25.0. Results: The mean score for maternal identity was 131.15 out of 160, and the mean scores for stress, depression, and spousal and familial support were 14.59 (out of 40), 6.82 (out of 30), and 109.04 (out of 132), respectively. Stress (r=-.38, p<.001), depression (r=-.37, p<.001), and spousal and familial support (r=.37, p<.001) were significantly correlated with maternal identity. In multiple regression analysis, stress (ß=-0.27, p=.005) and spousal and familial support (ß=0.23, p=.014) were found to be significant factors influencing maternal identity in pregnant women (F=14.19, p<.001). Conclusion: It is necessary to develop effective strategies to mitigate stress and to encourage spousal and familial support in pregnant women. Such strategies could further enable pregnant women to enhance their maternal identity.

The Association Between Perceived Stress and Quality of Life in University Students: The Parallel Mediating Role of Depressive Symptoms and Health-Promoting Behaviors.

PURPOSE: This study examined whether depressive symptoms and health-promoting lifestyle behaviors mediate the association between perceived stress and quality of life (QoL) in university students. METHODS: Using a cross-sectional survey, Korean university students (N = 187, Mage = 23.97 years; 54.0% Woman) completed structured questionnaires with psychometric adequacy. A parallel multiple mediation model was used to test the mediating effect of depressive symptoms and health-promoting lifestyle behaviors on the relationship between perceived stress and QoL. RESULTS: Total effect of perceived stress, depressive symptoms, and health-promoting lifestyle behaviors on QoL was -.55. Of these, total indirect mediating effect was -.50, whereas direct effect was only -.05 in the parallel mediation model. In particular, depressive symptoms (indirect effect = -.32) and health-promoting lifestyle behaviors (indirect effect = -.18) completely mediated the relationship between perceived stress and QoL. CONCLUSION: The results suggest that effective strategies primarily focusing on improving depressive symptoms along with health behaviors are needed to decrease the negative effect of perceived stress on QoL.

The adaptation process of mothers raising a child with complex congenital heart disease.

Mothers of children with congenital heart disease (CHD) tend to be concerned about their child's normal life. The majority of these mothers tend to experience negative psychological problems. In this study, the adaptation process of mothers raising a child with complex CHD was investigated based on the sociocultural context of Korea. The data collection was conducted by in-depth interviews and theoretical sampling was performed until the data were saturated. The collected data were analyzed using continuous theoretical comparisons. The results of the present study showed that the core category in the mothers' adaptation process was 'anxiety regarding the future', and the mothers' adaptation process consisted of the impact phase, standing against phase, and accepting phase. In the impact phase, the participants emotionally fluctuated between 'feelings of abandonment' and 'entertaining hope'. In the standing against phase, participants tended to dedicate everything to child-rearing while being affected by 'being encouraged by support' and 'being frustrated by tasks beyond their limits'. In the accepting phase, the subjects attempted to 'accept the child as is', 'resist hard feelings', and 'share hope'. Health-care providers need to develop programs that include information regarding CHD, how to care for a child with CHD, and effective child-rearing behaviors.

Factors related to low birth rate among married women in Korea.

The purpose of this study was to explore the factors influencing low birth rate among married women using the National Survey data in Korea. We compared the different influences on women's first and subsequent childbirths. This study was a secondary analysis using the "National Survey on Fertility and Family Health and Welfare", which was a nationally representative survey conducted by the Korea Institute for Health and Social Affairs. We analyzed the data of 3,482 married women (aged between 19 and 39 years) using SPSS 20.0 program for descriptive statistics, t-test, one-way ANOVA, and binary and ordinal logistic regression models. The factors influencing women's first childbirth included perceptions about the value of marriage and children and their education level. The factors influencing their subsequent childbirths included multifaceted variables of maternal age during the first childbirth, residential area, religion, monthly household income, perceptions about the value of marriage and children, and social media. It is necessary to improve women's awareness and positive perceptions about marriage and children in order to increase the birth rate in Korea. Moreover, consistently providing financial and political support for maternal and childcare concerns and using social media to foster more positive attitudes toward having children may enhance birth rates in the future.