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1.
Int J Nurs Pract ; : e12819, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31997511

RESUMO

AIMS: This study aimed to identify the nursing stress factors, which affect turnover intention in hospital nurses. BACKGROUND: Nursing stress is known to be an important predictor of turnover intention in nurses. Although nurses experience various sources of stress across work environments, cultures, and generations, little is known about the stress factors affecting turnover intention in nurses. DESIGN: A descriptive cross-sectional design was employed. METHODS: A total of 329 nurses were recruited through convenience sampling from 27 hospitals in South Korea. Data were collected from May to November 2018 using a questionnaire. RESULTS: Among the stress factors, stress from patients and their families, workload stress, stress from conflicts with supervisors, and stress from conflicts with peers were associated with turnover intention in hospital nurses. These variables explained 40.0% of the variance in turnover intention among hospital nurses. CONCLUSIONS: Stress from interpersonal relationships with patients and their families, supervisors, and peers may have a considerable impact on turnover intention. To reduce nursing turnover intention, coping strategies to reduce stress from patients and their families should be established. It is necessary to provide programmes that foster interpersonal relationship skills in the workplace. Nurse managers may encourage communication among nurses to establish positive relationships.

2.
Eur J Neurol ; 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-31999861

RESUMO

BACKGROUND: The patterns of head-shaking nystagmus (HSN) aid in differentiation between the central and peripheral vestibular disorders, and perverted HSN (pHSN) has been considered a central sign. OBJECTIVES: To determine the characteristics of HSN in a large number of patients with either peripheral or central vestibular disorders in a dizziness clinic of a university hospital. METHODS: We reviewed the medical records of 7,544 dizzy patients during a year and recruited 822 patients with a clinical diagnosis of vestibular disorders. The findings of spontaneous (SN) and head-shaking nystagmus in these patients were compared with those of healthy controls (n=48). RESULTS: A total of 217 of the 822 patients (26.4%) were classified as having a central vestibular disorder group, while 397 (48.3%) had a peripheral vestibular disorder group. In the peripheral vestibular disorder group, SN was observed in 14.1%, and HSN in 40.8%, among which 24.1% was the perverted form of HSN (pHSN). In the central group, SN was observed in 17.5%, and HSN in 24.0% of which 57.7% was pHSN. HSN was more frequently observed in the peripheral vestibular disorder group than it was in the central group (40.8% vs. 24.0%, p<0.01). However, the proportion of pHSN was significantly increased in the central group compared to that of the peripheral vestibular patient group (57.7% vs. 24.1%, p<0.01). CONCLUSIONS: Since pHSN is not specific for central vestibular disorders, other clinical features should be considered in pursuing a central lesion in patients with pHSN.

3.
Semin Neurol ; 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31935768

RESUMO

Isolated dizziness and vertigo due to vascular mechanisms are frequently misdiagnosed as peripheral vestibulopathy or vestibular migraine. For diagnosis of strokes presenting with an acute prolonged (≥ 24 hours) vestibular syndrome, findings on clinical examination, such as HINTS (negative head impulse tests, detection of direction-changing gaze-evoked nystagmus, and presence of skew deviation), are more sensitive than findings on neuroimaging. Since HINTS alone cannot securely detect anterior inferior cerebellar artery strokes, additional attention should be paid to the patients with unexplained hearing loss in addition to acute prolonged vestibulopathy. For diagnosis of transient (< 24 hours) spontaneous vestibular syndrome due to vascular mechanisms, the presence of associated craniocervical pain and focal neurological symptoms/signs is the clue. Even without these symptoms or signs, however, vascular imaging combined with perfusion- and diffusion-weighted MRI should be performed in patients with multiple vascular risk factors or a high ABCD2 score (age, blood pressure, clinical features, duration of symptom, and presence of diabetes).

4.
Semin Neurol ; 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31935769

RESUMO

Bilateral vestibular dysfunction (BVD) refers to hypofunction of the vestibular nerves or labyrinths on both sides. Patients with BVD present with dizziness, oscillopsia, and unsteadiness, mostly during locomotion, which worsen in darkness or on uneven ground. Although aminoglycoside ototoxicity, Meniere's disease, infection, and genetic disorders frequently cause BVD, the etiology remains undetermined in up to 50% of the patients. The diagnosis of BVD requires both symptoms and documentation of deficient vestibulo-ocular reflex function using head-impulse, bithermal caloric, and rotatory chair tests. Since various neurologic and systemic disorders may present with BVD, clinicians should be cautious not to overlook the symptoms and signs of central nervous system and systemic involvements. Vestibular rehabilitation, application of vibrotactile and auditory feedbacks, and vestibular prosthesis can aid the patients with BVD along with the correction of the underlying causes.

5.
J Nurs Res ; 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31904736

RESUMO

BACKGROUND: Compared with older adults, young adults exhibit poor treatment and control of hypertension. However, little is known about the factors affecting the treatment and control of hypertension in young adults. PURPOSE: This study was aimed to identify the factors affecting the treatment and control of hypertension in early adulthood by gender in South Korea. METHODS: This secondary data analysis study used a data set from the Korean National Health and Nutrition Examination Survey. The inclusion criteria were as follows: (a) 19-44 years old and (b) having an indicator of hypertension (systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or taking antihypertensive drugs). Seven hundred eighty participants were included in this study. The odds ratios and 95% confidence intervals were derived using composite-sample multiple logistic regression. RESULTS: In men, age, marital status, family history of hypertension, treatment of hyperlipidemia, abdominal obesity, high-sodium diet, cholesterol, and aerobic exercise were found to be associated with hypertension treatment and control. In women, age, employment status, cardiovascular risk factors, body mass index, high-sodium diet, and drinking were found to be associated with hypertension treatment and control. CONCLUSIONS: The factors affecting the treatment and control of hypertension differed between the two genders. Therefore, healthcare providers should consider the differences in the factors between the two genders in early adulthood. To improve the treatment and control of hypertension, the guidelines for treatment interventions and management should be gender-specific from early adulthood. Nurses should actively suggest health-related behavioral modifications such as performing aerobic exercise for young adult men and reducing alcohol consumption for women.

6.
Curr Opin Neurol ; 33(1): 142-149, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31789704

RESUMO

PURPOSE OF REVIEW: The current review covers recent advances in vascular vertigo in terms of diagnostic strategies, clinical/laboratory features, pathophysiology, and differential diagnosis. RECENT FINDINGS: Acute strokes presenting with isolated dizziness/vertigo without other obvious symptoms or signs of central nervous system involvements may be easily mistaken as peripheral vestibulopathy. For correct diagnosis of vascular vertigo, the importance of clinical history (timing and triggers) and targeted bedside examination cannot be overemphasized. In addition to Head Impulse-Nystagmus-Test of Skew, several differential strategies have been advanced by adopting a combination of clinical history, bedside or laboratory examination, and imaging for diagnosis of vascular vertigo. Circumscribed cerebellar and brainstem lesions may cause isolated central vestibular syndromes with characteristic vestibular and ocular motor manifestations. Recognition of these findings would aid in localizing the lesions and understanding the function of each central vestibular structure. Central positional nystagmus (CPN) may mimic benign paroxysmal positional vertigo (BPPV), but additional oculomotor or neurological findings mostly permit differentiation of CPN from BPPV. SUMMARY: In acute vestibular syndrome, discriminating vascular causes is still challenging especially when other central symptoms and signs are not evident. An integrated approach based on understanding of clinical features, laboratory findings, speculated mechanisms, and limitations of current diagnostic tests will lead to better clinical practice.

7.
J Nurs Scholarsh ; 52(1): 105-112, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31758662

RESUMO

PURPOSE: This study aimed to examine the associations among emotional labor strategies, stress from emotional labor, and burnout in nurses. DESIGN: We employed a descriptive cross-sectional design. Data were collected from May to November 2018 in South Korea using structured questionnaires. Participants were 303 nurses from 27 hospitals, who were recruited by convenience sampling. METHODS: Emotional labor strategies (surface acting, deep acting, and expression of naturally felt emotions), stress, and burnout were self-reported. A path analysis using structural equation modeling was performed to examine the associations among the study variables. FINDINGS: Bivariate analyses revealed that surface acting was positively correlated with stress and burnout, deep acting was negatively correlated with burnout, and naturally felt emotions were negatively correlated with stress and burnout. The path analysis revealed that surface acting was positively associated with stress, naturally felt emotions were negatively associated with burnout, and the stress from emotional labor was positively associated with burnout. Although surface acting was not directly associated with burnout, it was indirectly associated through stress. CONCLUSIONS: Surface acting involves regulation and suppression of one's felt emotions. The findings of this study suggest that hospitals need to reduce expectations for surface acting to reduce nurses' stress and burnout. Organizational efforts to provide interventions that improve nurses' ability to manage their emotions in interactions with patients might effectively foster nurses' well-being. CLINICAL RELEVANCE: Surface acting might contribute to nurses' burnout, and naturally felt emotions might reduce nurses' burnout. Nurse managers should thus provide opportunities to discuss the utilized emotional labor strategies and encourage appropriate responses depending on the patient context. Programs that promote emotional competence may reduce the adverse effects associated with nurses' emotional labor and foster effective coping strategies.

10.
Sci Rep ; 9(1): 17877, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31784588

RESUMO

Wearable sweat sensors have enabled real-time monitoring of sweat profiles (sweat concentration versus time) and could enable monitoring of electrolyte loss during exercise or for individuals working in extreme environments. To assess the feasibility of using a wearable sweat chloride sensor for real-time monitoring of individuals during exercise, we recorded and analyzed the sweat profiles of 50 healthy subjects while spinning at 75 Watts for 1 hour. The measured sweat chloride concentrations were in the range from 2.9-34 mM. The sweat profiles showed two distinct sweat responses: Type 1 (single plateau) and Type 2 (multiple plateaus). Subjects with Type 2 profiles had higher sweat chloride concentration and weight loss, higher maximum heart rate, and larger changes in heart rate and rating of perceived exertion during the trial compared to subjects with Type 1 profiles. To assess the influence of level of effort, we recorded sweat profiles for five subjects at 75 W, 100 W, and 125 W. While all five subjects showed Type 1 sweat profiles at 75 W, four of the subjects had Type 2 profiles at 125 W, showing an increase in sweat chloride with exercise intensity. Finally, we show that sweat profiles along with other physiological parameters can be used to predict fluid loss.

11.
Cerebellum ; 2019 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-31838647

RESUMO

We report atypical opsoclonus in a patient with multiple system atrophy and propose a mechanism based on the patterns of modulation by visual, vestibular, and saccadic and vergence stimulation. Firstly, the 6-Hz opsoclonus mostly in the vertical plane occurred only after the development of downbeat nystagmus in darkness without visual fixation. Even after a substantial build-up, visual suppression of the opsoclonus was immediate and complete. Furthermore, the latency for re-emergence of opsoclonus in darkness was greater when the duration of preceding visual fixation was longer. Secondly, the effect of preceding downbeat nystagmus on the development of opsoclonus was evaluated by changing the head position. The opsoclonus did not occur in the supine position when the downbeat nystagmus was absent. After horizontal head shaking, the opsoclonus in the vertical plane gradually evolved into horizontal plane and resumed its vertical direction again after vertical head shaking. Thirdly, any opsoclonus was not triggered by imaginary saccades in the supine position. Lastly, combined vergence and saccadic eye movements during the Müller paradigm did not induce opsoclonus. From these findings of modulation, we suggest that the opsoclonus observed in our patient was invoked by vestibular signals. When the function of the omnipause neurons and saccadic system was impaired, the centrally mediated vestibular eye velocity signals may activate the saccadic system to generate opsoclonus. These atypical patterns of opsoclonus, distinct from the classic opsoclonus frequently observed in para-neoplastic or para-infectious disorders, may be an unrevealing sign of degenerative brainstem or cerebellar disorders.

12.
J Cosmet Dermatol ; 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31803993

RESUMO

BACKGROUND: Although there are various techniques of thread lifting, most of these techniques require anchoring of the threads at the temple area. However, the frontal branch of the superficial temporal artery (FBrSTA) is located in the temple area and a detour pathway should be created for thread insertion to avoid vascular complications. OBJECTIVES: We aimed to determine the relationship between the FBrSTA and the hairline using real-time Doppler ultrasound. METHODS: Doppler ultrasound was used to detect the FBrSTA pathway, and the relationship between the hairline and the FBrSTA was analyzed. After confirming the arterial pathway, thread lifting was performed in patients, and complications related to the entry point and insertion of the threads were evaluated. Patient satisfaction was evaluated immediately after the procedure and 3 months later. RESULTS: This study included 50 patients (45 women and 5 men; age: 51 [range 26-71] years) who underwent thread lifting in a single institution from January to May 2019 after Doppler ultrasound-guided detection of the FBrSTA. No vascular complications were noted in all patients. CONCLUSIONS: Our findings suggest that Doppler ultrasound can be used to detect the FBrSTA at the temple area to avoid vascular complications during thread lifting.

13.
Artigo em Inglês | MEDLINE | ID: mdl-31769495

RESUMO

CONTEXT: Mutations in LAMB2, encoding the basement membrane protein, laminin ß2, are associated with an autosomal recessive disorder characterized by congenital nephrotic syndrome, ocular abnormalities and neurodevelopmental delay (Pierson Syndrome). CASE DESCRIPTION: This report describes a twelve year old boy with short stature, visual impairment and developmental delay who presented with macroscopic haematuria and albuminuria. He had isolated growth hormone deficiency, optic nerve hypoplasia and a small anterior pituitary with corpus callosum dysgenesis on his cranial MRI, thereby supporting a diagnosis of optic nerve hypoplasia syndrome. Renal histopathology revealed focal segmental glomerulosclerosis. Using next generation sequencing on a targeted gene panel for steroid resistant nephrotic syndrome, compound heterozygous missense mutations were identified in LAMB2 [c.737G>A p.Arg246Gln, c.3982G>C p.Gly1328Arg]. Immunohistochemical analysis revealed reduced glomerular laminin ß2 expression compared to control kidney and a thin basement membrane on electron microscopy. Laminin ß2 is expressed during pituitary development and Lamb2-/- mice exhibit stunted growth, abnormal neural retinae and here, we show, abnormal parenchyma of the anterior pituitary gland. CONCLUSION: We propose that patients with genetically undefined optic nerve hypoplasia syndrome should be screened for albuminuria and if present, screened for mutations in LAMB2.

14.
Nurs Health Sci ; 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31650677

RESUMO

This study examined the relationships among family socioeconomic status, parental attention, and health behaviors in children during middle childhood. For this descriptive cross-sectional study, six elementary schools in a metropolitan city in South Korea were selected for recruitment. We surveyed 857 elementary school students aged 8 to 10 years by using self-report questionnaires. A hierarchical multilinear regression analysis found that family socioeconomic status positively related to children's health behaviors and that parental attention had a moderating effect on this relationship. These results suggest that family socioeconomic status influences health behaviors from the child's perspective. The influence of family socioeconomic status on children's health behaviors might be weakened by parental attention. Healthcare providers should be aware of children's health behaviors and focus interventions on families with low socioeconomic status. Nurses should emphasize to parents that parental supervision and monitoring might benefit their children and improve their health behaviors.

15.
Graefes Arch Clin Exp Ophthalmol ; 257(12): 2631-2638, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31654187

RESUMO

PURPOSE: To investigate the changes in the near reading speed after panretinal photocoagulation (PRP) in diabetic retinopathy patients. METHODS: This non-randomized, prospective, clinical study enrolled diabetic retinopathy patients who underwent PRP from January 2016 to June 2017. The near reading speed was measured before and 1 week, 1 month, and 4 months after PRP by using an iPad application for the assessment of reading speed; near best-corrected visual acuity (BCVA) and subfoveal choroidal thickness (SFCT) were also analyzed. The reading speed of age-matched healthy individuals was compared with that of diabetic retinopathy patients. RESULTS: Forty-seven patients were enrolled in this study. The baseline near reading speed of diabetic retinopathy patients was significantly slower than that of age-matched healthy controls. The near reading speed was reduced at 1 week after PRP, but recovered at 1 and 4 months after PRP. Near BCVA showed a similar pattern after PRP. SFCT increased at 1 week after PRP and significantly decreased at both 1 and 4 months after PRP. CONCLUSION: The near reading speed of diabetic patients was significantly slower than that of age-matched healthy controls. The speed was temporarily reduced at 1 week after PRP, potentially due to short-term impairment of parasympathetic nerve innervation.

16.
Artigo em Inglês | MEDLINE | ID: mdl-31623067

RESUMO

This study aimed to determine the association between the number of existing teeth (NET) and socioeconomic status (SES), oral health-related behaviours, and metabolic syndrome in Korean adults aged 55-79 years. The study included 3255 adults who underwent oral health examinations and answered questionnaires regarding SES, oral health-related behaviours, and metabolic diseases in the Sixth Korea National Health and Nutrition Examination Survey (2013-2015). The dependent variable was the binary status based on the median NET in each age group. The independent variables were based on SES, oral health-related behaviours, and the presence of metabolic syndrome. The study findings showed that the factors associated with the NET were sex, household income, education level, region of residence, daily toothbrushing frequency, dental visit within 1 year, smoking, and metabolic syndrome. NET was lower in males (adjusted OR: 0.74), in low household income group (adjusted OR: 0.77), in primary school graduates (adjusted OR: 0.53), in rural residents (adjusted OR: 0.78), and in medicaid beneficiaries (adjusted OR: 0.78). The interventions aimed at preserving existing teeth in elderly population should consider their SES, oral health-related behaviours, and metabolic syndrome and overhauling current oral healthcare system and redefining the roles of oral health professionals.

17.
Front Neurol ; 10: 1035, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31611841

RESUMO

Objectives: To reveal the neural basis of Wernicke's encephalopathy (WE) with impaired vestibulo-ocular reflex (VOR), we evaluated resting-state functional connectivity (rs-fc) in the vestibular processing brain regions. Methods: Rs-fc between the vestibular regions and the rest of the brain were compared with neurotological features including the head-impulse tests (vHIT) and caloric responses in patients with WE (n = 5, mean age 53.4 ± 10 years) and healthy controls (n = 20, mean age 55.0 ± 9.2 years). Rs-fc analyses employed a region of interest (ROI)-based approach using regions selected a priori that participate in vestibular processing including the cerebellar vermis, insula, parietal operculum, and calcarine cortex. Results: The main neurologic findings for patients with WE were mental changes; gait ataxia; spontaneous and gaze-evoked nystagmus (GEN); and bilaterally positive HIT for the horizontal canals. Video HIT documented bilateral horizontal canal dysfunction with decreased gain and corrective saccades. Caloric irrigation and rotation chair testing revealed prominent bilateral horizontal canal paresis. Patients with WE also had decreased spatial memory, which substantially recovered after treatments. Functional connections at the predefined seed regions, including the insular cortex and parietal operculum, were attenuated in the WE group compared to healthy controls. Conclusions: WE is related to impaired VOR and visuospatial dysfunction, and fMRI documented changes in the rs-fc of multisensory vestibular processing regions including the insula, parietal operculum, and superior temporal gyrus, which participate in integration of vestibular perception.

18.
Neurology ; 93(11): e1085-e1092, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31399495

RESUMO

OBJECTIVES: To delineate the clinical features and ocular motor findings in acute vestibular syndrome (AVS) associated with anti-GQ1b antibodies. METHODS: We reviewed 90 patients with positive serum anti-GQ1b antibody in association with various neurological syndromes at Seoul National University Bundang Hospital from 2004 to 2018. The diagnoses included typical Miller Fisher syndrome (n = 31), acute ophthalmoplegia without ataxia (n = 27), Guillain-Barre syndrome with ophthalmoplegia (n = 18), AVS (n = 11), and Bickerstaff brainstem encephalitis (n = 3). Of them, the 11 patients with AVS formed the basis of this study. We also conducted a systematic review on AVS reported in association with anti-GQ1b antibody. RESULTS: Patients with AVS showed various ocular motor findings that included head-shaking nystagmus (n = 6), spontaneous nystagmus (n = 5), gaze-evoked nystagmus (n = 5), central positional nystagmus (n = 3), canal paresis (n = 2), and abnormal head-impulse tests (n = 1) without any internal or external ophthalmoplegia. Compared to those with other subtypes, patients with AVS mostly showed normal deep tendon reflexes (8 of 11 [73%], p = 0.002) and normal results on nerve conduction studies (4 of 4 [100%], p = 0.010). The clinical and laboratory findings resolved or improved markedly in all patients within 6 months of symptom onset. Systematic review further identified 7 patients with AVS and positive serum anti-GQ1b antibody who showed various ocular motor findings, including gaze-evoked nystagmus, saccadic dysmetria, central positional nystagmus, and ocular flutter or opsoclonus. CONCLUSION: Anti-GQ1b antibody may cause acute vestibulopathy by involving either the central or peripheral vestibular structures. AVS may constitute a subtype of anti-GQ1b antibody syndrome.


Assuntos
Autoanticorpos/sangue , Gangliosídeos/sangue , Doenças Vestibulares/sangue , Doenças Vestibulares/diagnóstico , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
Front Neurol ; 10: 750, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31396141

RESUMO

Objectives: The aim of this study was to delineate the clinical and laboratory features suggestive of intralabyrinthine schwannoma (ILS). Methods: We compared the clinical features of 16 patients with ILS, who had been diagnosed at the Seoul National University Bundang Hospital from 2003 to 2018, with those of 18 patients with symptomatic unilateral intracanalicular schwannoma and randomly selected 20 patients with definite or probable unilateral Meniere's disease (MD). Results: Patients with ILS presented with either recurrent spontaneous dizziness/vertigo combined with auditory symptoms (n = 8), isolated auditory symptoms without dizziness/vertigo (n = 7), or recurrent spontaneous dizziness/vertigo without auditory symptoms (n = 1). Most patients reported no improvement (n = 11) or worsening (n = 1) of the symptoms despite medical treatments including intratympanic (n = 5) or intravenous steroids (n = 2). Conventional brain MRIs failed to detect ILS in about a half of the patients (7/16, 44%). However, ILS showed a filling defect on 3-dimensional (3D) heavily T2-weighted MRIs (n = 12), and nodular enhancement on 3D contrast-enhanced T1 (n = 15) or FLAIR MRIs (n = 13) targeted for the inner ear. Compared to MD or intracanalicular schwannoma, ILS showed mostly abnormal head-impulse tests (HITs, p = 0.001). In contrast, the incidence of canal paresis did not differ among the groups (p = 0.513). Conclusion: ILS may mimic MD by presenting recurrent dizziness/vertigo and auditory symptoms. ILS should be suspected in patients with recurrent audiovestibulopathy especially when (1) the duration of the dizziness is not typical for MD, (2) the patients do not respond to medical treatments, or (3) HITs are abnormal.

20.
Microbiol Resour Announc ; 8(31)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31371552

RESUMO

Severe fever with thrombocytopenia syndrome virus (SFTSV) is tick-borne and causes this disease (SFTS) in humans. We determined the complete genome sequences of two SFTSV strains isolated from serum from a human with SFTS and a dog with asymptomatic infection using reverse transcription and rapid amplification of cDNA ends PCR.

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