Digital Health Interventions for Adult Patients With Cancer Evaluated in Randomized Controlled Trials: Scoping Review.

BACKGROUND: Digital care has become an essential component of health care. Interventions for patients with cancer need to be effective and safe, and digital health interventions must adhere to the same requirements. OBJECTIVE: The purpose of this study was to identify currently available digital health interventions developed and evaluated in randomized controlled trials (RCTs) targeting adult patients with cancer. METHODS: A scoping review using the JBI methodology was conducted. The participants were adult patients with cancer, and the concept was digital health interventions. The context was open, and sources were limited to RCT effectiveness studies. The PubMed, CINAHL, Embase, Cochrane Library, Research Information Sharing Service, and KoreaMed databases were searched. Data were extracted and analyzed to achieve summarized results about the participants, types, functions, and outcomes of digital health interventions. RESULTS: A total of 231 studies were reviewed. Digital health interventions were used mostly at home (187/231, 81%), and the web-based intervention was the most frequently used intervention modality (116/231, 50.2%). Interventions consisting of multiple functional components were most frequently identified (69/231, 29.9%), followed by those with the self-manage function (67/231, 29%). Web-based interventions targeting symptoms with the self-manage and multiple functions and web-based interventions to treat cognitive function and fear of cancer recurrence consistently achieved positive outcomes. More studies supported the positive effects of web-based interventions to inform decision-making and knowledge. The effectiveness of digital health interventions targeting anxiety, depression, distress, fatigue, health-related quality of life or quality of life, pain, physical activity, and sleep was subject to their type and function. A relatively small number of digital health interventions specifically targeted older adults (6/231, 2.6%) or patients with advanced or metastatic cancer (22/231, 9.5%). CONCLUSIONS: This scoping review summarized digital health interventions developed and evaluated in RCTs involving adult patients with cancer. Systematic reviews of the identified digital interventions are strongly recommended to integrate digital health interventions into clinical practice. The identified gaps in digital health interventions for cancer care need to be reflected in future digital health research.

Predictors of long-term medication adherence in stroke survivors: A multicentre, prospective, longitudinal study.

BACKGROUND: Although the optimal use of prescribed medications for stroke survivors is critical for preventing secondary stroke, longitudinal observations of the natural course of medication persistence and adherence in Korean stroke survivors are rare. Furthermore, studies are needed to identify strong predictors influencing medication adherence and to determine whether these predictors change over time. AIMS AND OBJECTIVES: To evaluate the longitudinal medication persistence and adherence at 3 months and 1 year after discharge in all stroke patients and to identify predictors of long-term medication adherence in patients who can self-medicate. DESIGN: A multicentre, prospective, longitudinal descriptive study. METHODS: A total of 600 consecutive ischaemic stroke patients were recruited from three stroke centres across Korea, from 1 September, 2017 to 28 February, 2019. Various factors related to medication adherence suggested by the World Health Organisation were investigated through face-to-face interviews at each centre during hospitalisation. Medication persistence and adherence were assessed at 3 months and 1 year after discharge using the eight-item Morisky Medication Adherence Scale through telephone interviews. RESULTS: Of 537 survivors at 3 months, 526 (98.0%) were persistent and 472 (89.7%) were adherent. Of 493 survivors at 1 year, 477 (96.8%) were persistent and 392 (82.2%) were adherent. Medication belief, income and health literacy were statistically significant predictors of three-month medication adherence, which predicted one-year medication adherence with older age and low income. CONCLUSIONS: Among Korean stroke survivors, three-month and one-year medication persistence and adherence were relatively good. Medication beliefs and three-month medication adherence were important and modifiable factors predicting three-month adherence and one-year adherence, respectively. RELEVANCE TO CLINICAL PRACTICE: To increase long-term adherence to medication, various strategies are needed to improve beliefs about medication, taking into account the patient's age and level of knowledge. These interventions need to be initiated during hospitalisation to form early medication habits after discharge.

Factors affecting the occurrence of pressure injuries among patients receiving targeted temperature management after cardiac arrest.

BACKGROUND: Pressure injuries (PIs) are a well-known complication of critically ill patients admitted to the intensive care unit with targeted temperature management (TTM) after cardiac arrest (CA). However, little is known about the factors that impact the occurrence of PIs among these patients. OBJECTIVES: This study aimed to examine factors related to the occurrence of PIs among patients after CA treated with TTM. METHODS: This retrospective observational study collected data from 126 patients after CA aged 18 years or older from a single tertiary hospital admitted between January 2017 and December 2019. Demographic, clinical, and medical device-related characteristics were collected by patient chart review. Multivariable logistic regression analysis was performed to identify factors related to the occurrence of PIs. RESULTS: The study showed that the incidence of PIs was 31.8%. Patients who were male (odds ratio [OR], 4.80; 95% confidence interval [CI], 1.21-19.08), developed diarrhoea (OR, 4.90, 95% CI, 1.31-18.41), or were subjected to physical restraint (OR, 6.03; 95% CI, 1.52-23.96) were at a higher risk of developing PIs. A lower risk of developing PIs was associated with the Glasgow Coma Scale score greater than 13 on the third day of admission (OR, 0.08; 95% CI, 0.01-0.52), higher haemoglobin level (OR, 0.65; 95% CI, 0.49-0.86), or low nutritional risk index (≤100) (OR, 0.10; 95% CI, 0.02-0.57). CONCLUSIONS: Nurses should be aware that patients treated with TTM after CA are at a high risk of developing PIs from the moment of admission and should be closely monitored.

Predictive Model for Quality of Life in Patients 1 Year After First Stroke.

BACKGROUND: Because the recurrence rate of stroke increases 1 year after its initial occurrence, it is important to predict quality of life at this stage, although most functions are likely recovered. OBJECTIVES: We aimed to construct and verify a model of quality of life in patients 1 year post stroke by considering their characteristics at the time of the stroke based on the Wilson and Cleary model and previous literature. METHODS: Participants comprised 288 patients who had experienced their first ischemic stroke and were enrolled in 3 regional stroke centers in South Korea. Data were analyzed using path analysis to identify a model of patients' quality of life 1 year post stroke. RESULTS: Age, National Institutes of Health Stroke Scale score, the modified Rankin Scale score, and anxiety had a direct effect on quality of life, whereas type D personality and social support had an indirect effect. Type D personality, age, National Institutes of Health Stroke Scale score, social support, the modified Rankin Scale score, and anxiety explained 32.9% of the total variance in quality of life. CONCLUSIONS: When predicting quality of life in a patient 1 year after a stroke, it is important to consider variables such as type D personality, age, National Institutes of Health Stroke Scale score, social support, the modified Rankin Scale score, and anxiety at the time of the first stroke. Interventions to improve the quality of life of patients with stroke should consider these factors.

Factors Influencing 1-Year Medication Adherence of Korean Ischemic Stroke Survivors.

BACKGROUND: Medication adherence is important for secondary stroke prevention. However, suboptimal adherence to medication among patients after stroke or transient ischemic attack is reportedly 30.9%. We assessed medication adherence of Korean stroke survivors within 1 year of acute ischemic stroke and identified factors that influence adherence. METHODS: We consecutively enrolled ischemic stroke survivors who visited the Department of Neurology of a university hospital from March 9 to June 15, 2016. Data were collected by face-to-face interviews using a structured questionnaire which assessed general characteristics, clinical characteristics, medication beliefs, social support, and depression. Medication adherence was measured using the 8-item Morisky Medication Adherence Scale. Multiple logistic regression was used to identify factors independently associated with medication adherence. RESULTS: Of the total 250 participants, 183 (73%) were in the optimal adherence group. Age (p = 0.035), smoking (p = 0.020), number of prescribed medicines (p = 0.037), frequency of daily doses (p = 0.040), and beliefs about medication (p < 0.001) were associated with medication adherence. Optimal medication adherence was associated with being a non-smoker (OR, 3.19; 95% CI, 1.29-7.87; p = 0.012), more prescribed medicines (OR, 1.27; 95% CI, 1.05-1.54; p = 0.014), less frequency of daily doses (OR, 0.37; 95% CI, 0.18-0.79; p = 0.010), and stronger beliefs about medication (OR, 1.09; 95% CI, 1.03-1.15; p = 0.004). CONCLUSION: To improve medication adherence of stroke survivors, post-stroke care should focus on bolstering patients' belief in the necessity of medication and encouraging lifestyle modifications, such as quitting smoking, as well as prescribing medicine with simple regimens.

Performance and Influencing Factors of Evidence-Based Pressure Ulcer Care Among Acute Care Hospital Nurses.

BACKGROUND: In previous studies about performance or factors affecting pressure ulcer (PU) care, old tools with nonupdated contents about the prevention and intervention of PU have been mainly used. Thus, there is little known how well evidence-based PU care is performed and what its' influencing factors are recently. AIMS: This study aimed to evaluate the PU care performance, based on evidence-based practice guidelines, and identify factors affecting it while considering nurses' individual and institutional characteristics. METHODS: We recruited 199 nurses involved in PU care, from August 20 to September 10, 2016, at two PU-related academic conferences in Korea. To examine PU care performance and knowledge as a related factor, we developed tools based on recent guidelines. To identify factors affecting PU care performance, we examined nurses' (individual level) and their institutions' (institutional level) characteristics, and analyzed using a hierarchical multiple regression test. RESULTS: Mean PU care performance of nurses was rated 3.99 out of 5. Performance level in "wound care: debridement"; "pain control"; "prevention skin care"; "incontinence management"; "supporting surface"; and "nutrition in PU prevention and treatment" was below average. Interest in PU care (ß = .28, p = <.001), the main PU manager in a ward being a wound, ostomy, continence nurse (ß = .22, p = .013), and an institution with a nursing practice guideline for PU care (ß = .16, p = .02) were identified as significant factors affecting a good PU care performance. LINKING EVIDENCE TO ACTION: To improve nurses' evidence-based PU care performance, nurses must recognize PU care's importance and take responsibility for improving their own performance. At the institutional level, systematic evidence-based guidelines and support systems, such as activating wound specialists, must be implemented. The academic society can support these initiatives by updating continuously the national guideline on PU prevention and management for ease of use by nurses or institutions.

The Validity and Reliability of the Korean Version of the Stigma Scale for Chronic Illness 8-Items (SSCI-8) in Patients with Neurological Disorders.

PURPOSE: The aim of this study was to develop a Korean version of the Stigma Scale for Chronic Illness 8-items (SSCI-8) and then assess its reliability and construct validity among patients with neurological conditions. METHOD: Patients diagnosed with stroke, Parkinson's disease, epilepsy, multiple sclerosis, myasthenia gravis, and amyotrophic lateral sclerosis were recruited. Reliability was assessed for internal consistency with Cronbach's alpha coefficient. Exploratory factor analysis (EFA) was used to extract potential factors of Korean SSCI-8. Convergent validity was assessed by correlating scores on the Korean SSCI-8 with scores for depression using the Beck Depression Inventory, anxiety using Spielberger's State-Trait Anxiety Inventory, and functional ability using the Korean modified Barthel Index (K-MBI), respectively. RESULTS: Of the total 202 patients enrolled in this study, 119 (58.9 %) were recruited with stroke, 33 (16.3 %) with Parkinson's disease, and 29 (14.4 %) with epilepsy. The Korean SSCI-8 had a high internal consistency (Cronbach's alpha = 0.90). The Korean SSCI-8 retrieved one factor from eight items by the EFA, and all factor loading scores were above 0.70 (0.71-0.84). The Korean SSCI-8 was correlated positively with depression (r = 0.74, p < 0.001) and anxiety (r = 0.61, p < 0.001), and negatively with the K-MBI (r = -0.48, p < 0.001). CONCLUSION: This study shows that the Korean SSCI-8 is a unidimensional model, even though it includes items of both enacted and internalized stigma. It is both reliable and valid for assessing stigma among Korean patients with neurological disease.

Factors contributing to malnutrition in patients with Parkinson's disease.

Our objective in this study was to evaluate the nutritional status and to identify clinical, psychosocial, and nutritional factors contributing to malnutrition in Korean patients with Parkinson's disease. We used a descriptive, cross-sectional study design. Of 102 enrolled patients, 26 (25.5%) were malnourished and 27 (26.5%) were at risk of malnutrition based on Mini-Nutritional Assessment scores. Malnutrition was related to activity of daily living score, Hoehn and Yahr stage, duration of levodopa therapy, Beck Depression Inventory and Spielberger's Anxiety Inventory scores, body weight, body weight at onset of Parkinson's disease, and body mass index. On multiple logistic regression analysis, anxiety score, duration of levodopa therapy, body weight at onset of Parkinson's disease, and loss of body weight were significant factors predicting malnutrition in Parkinson's disease patients. Therefore, nutritional assessment, including psychological evaluation, is required for Parkinson's disease patients to facilitate interdisciplinary nutritional intervention for malnourished patients.

Exploring nurses' experiences in pressure sore care in long-term care facilities.

BACKGROUND: This study uses an interpretive description approach to explore nurses' experiences with pressure sore care in long-term care facilities, highlighting the complexity of their encounters. METHODS: 10 experienced nurses from South Korean small to medium-sized hospitals were chosen via purposive sampling for interviews. Data analysis utilized Braun and Clarke's reflexive thematic analysis. RESULTS: The study's findings collectively reflect the intricate journey of nurses in Long-term care facilities as they grapple with the challenges of pressure sore care. These nurses transform their perception of pressure sores, encountering a dynamic shift in their understanding. They face multifaceted challenges in providing optimal care, marked by resource constraints and the absence of standardized guidelines. Emotionally, they navigate a complex terrain of sentiments, oscillating between feelings of accomplishment and helplessness. Despite these hurdles, they persistently strive for excellence in pressure sore nursing, driven by an unwavering commitment to delivering the best possible care within the confines of their healthcare environment. CONCLUSION: The study enhances understanding of pressure sore care in long-term facilities and suggests avenues for improving nursing practices and care quality through targeted interventions.

The needs for digital health and eHeath literacy of cancer patients, caregivers, and healthcare providers: A multicenter, descriptive correlational study.

PURPOSE: Digital health is an indispensable tool, but its use depends on the eHealth literacy (eHL) of end-users. This study aimed to understand the need for digital health and eHL among cancer patients, caregivers, and healthcare providers and to identify differences in digital health needs related to the eHL of cancer patients. METHODS: A multicenter, descriptive correlational study was conducted and included a total of 209 patients, 150 caregivers and 150 healthcare providers. Digital health needs were identified, and eHL was measured using the Korean version of the eHealth Literacy Scale. Differences in digital health needs in relation to the eHL of patients were analyzed. RESULTS: The most necessary digital health functions among cancer patients and caregivers were 'information and education on symptom management after cancer treatment' and 'education on coping methods for each type of cancer' (87.1-94.0%). Healthcare providers reported the need for a digital health function for 'medication information' and assisting in 'medical appointments' (96.7-98.0%). The preferred types of digital health were telemonitoring, mobile services, and telemedicine by telephone (81.3-90.5%). The mean eHL score of the cancer patients was 28.84 ± 6.75. Differences existed in the need for digital health functions and preferences for digital health types between cancer patients with high and low eHL. CONCLUSIONS: Cancer patients and caregivers expressed strong needs for digital health that provide information and education about symptom management and coping with cancer. Digital health interventions for cancer care need to be developed to reflect the identified needs and preferences and eHL of end-users.

Effects of digital self-management symptom interventions on symptom outcomes in adult cancer patients: A systematic review and meta-analysis.

PURPOSE: Digital self-management (SM) interventions targeting symptom relief have demonstrated positive as well as null outcomes, whereas no study has synthesized the effect of the interventions. In this study, we aimed to evaluate the effectiveness of digital SM symptom interventions on symptom outcomes in adult cancer patients. METHODS: A systematic review and meta-analysis based on the previous scoping review was conducted. Six databases (PubMed, CINAHL, Embase, the Cochrane Library, RISS [Korean], and KoreaMed [Korean]) were searched. Population was adult cancer patients. Intervention was SM interventions applying digital health tool targeting symptom management. Comparison was usual care, waitlist controls or active controls. The primary outcome was symptom burden, and the secondary outcomes were individual symptoms. RESULTS: Our meta-analysis of 32 randomized controlled trials (RCTs) including 7888 patients demonstrated that digital SM symptom interventions had a significant effect on reducing symptom burden (effect size [ES] = -0.230) and relieving pain (ES = -0.292), fatigue (ES = -0.417), anxiety (ES = -0.320), and depression (ES = -0.261). CONCLUSIONS: Digital SM interventions can improve symptom outcomes in adult cancer patients. Oncology nurses should be aware that digital SM interventions have demonstrated promising outcomes in cancer patient care.

Factors Related to Beliefs about Medication in Ischemic Stroke Patients.

Background: Medication beliefs are known as predictors of medication adherence. However, understanding of the relevance of these beliefs is lacking. Therefore, this study aimed to identify medication beliefs, and their influencing factors, in stroke survivors. Methods: This was a secondary analysis, using baseline data from a longitudinal study conducted to predict long-term medication adherence in Korean stroke survivors, and included 471 patients. Medication beliefs were investigated using the Belief about Medicine Questionnaire (BMQ), and the belief score and attitudes were derived from the "necessity" and "concern" scores, which are subscales of the BMQ. Multiple linear regression was used to determine independent factors influencing medication beliefs. Results: The mean score of medication beliefs is 7.07 ± 6.32, and the accepting group comprises 288 patients (61.1%). Medication beliefs are significantly higher in older adults (p < 0.001), females (p = 0.001), and patients with non-type D personality (p = 0.023), low-state anxiety (p < 0.001), high stroke severity (p = 0.001), a high number of medications (p < 0.001), and high knowledge about medications (p = 0.001). Conclusion: This study shows that type D personality, state anxiety, and knowledge about medication are major mediating factors for improving medication beliefs. These results may help healthcare professionals develop strategies to enhance medication adherence, by improving patients' medication beliefs.

MRI findings may predict early neurologic deterioration in acute minor stroke or transient ischemic attack due to intracranial atherosclerosis.

BACKGROUND: Patients with intracranial atherosclerosis (ICAS) are at high risk of early recurrence or neurologic deterioration. Although minor stroke and transient ischemic attack (TIA) seem benign, their occurrence in patients with ICAS may lead to early neurological deterioration (END). We aimed to identify factors associated with END in ICAS patients presenting with acute minor stroke or TIA, with a focus on early MRI findings. METHODS: This was a retrospective analysis of consecutive patients with acute minor stroke or TIA admitted within 12 h of symptom onset. Patients with moderate-severe stenosis of the middle cerebral artery or basilar artery (BA) were included. All patients underwent MRI, including diffusion-weighted imaging (DWI), and magnetic resonance angiography. DWI lesion patterns were classified as perforating artery infarcts, pial infarcts, territorial infarcts and border zone infarcts (BIs). END was diagnosed as an increase of > or =4 points on the National Institutes of Health Stroke Scale from baseline during the 1st week. RESULTS: Of the 95 patients enrolled in the study, 14 (14.7%) developed END. Independent predictors of END were the presence of BIs on baseline DWI (odds ratio, OR, 7.21; 95% confidential interval, CI, 1.88-27.66; p = 0.004) and BA disease (OR, 4.33; 95% CI, 1.11-16.92; p = 0.035). CONCLUSIONS: ICAS patients with BI and BA disease are at high risk of END after minor stroke or TIA. Early radiological findings may be helpful in predicting END and guiding early treatment strategies.

The Reliability and Validity of the Korean Short Version of the Stroke-Specific Quality of Life Scale.

PURPOSE: The aim of this study was to assess the reliability and validity of the Korean short version of the Stroke-Specific Quality of Life Scale (SS-QoL-12K). DESIGN: A descriptive, cross-sectional design was used. METHODS: We recruited 233 outpatients with ischemic stroke. FINDINGS: The Cronbach's alpha coefficients for internal consistency was .93, and the test-retest reliability value was .98. Confirmatory factor analysis identified two dimensions for the SS-QoL-12K. The SS-QoL-12K was correlated positively with the 36-Item Short Form Health Survey score and Instrumental Activities of Daily Living and negatively with the modified Rankin Scale score. The SS-QoL scores in the National Institutes of Health Stroke Scale mild group were higher than those in the National Institutes of Health Stroke Scale moderate and severe groups. CONCLUSIONS: This study shows that the SS-QoL-12K has a satisfactory level of reliability and validity in patients with ischemic stroke. CLINICAL RELEVANCE: This instrument will be helpful in advancing research and clinical care for stroke patients.

Inflammatory and hemostatic biomarkers associated with early recurrent ischemic lesions in acute ischemic stroke.

BACKGROUND AND PURPOSE: Early recurrent ischemic lesions (ERILs) on diffusion-weighted imaging after acute ischemic stroke have been suggested as a potential marker of early recurrent stroke. We hypothesized that biomarkers of inflammation or coagulation may be associated with the pathogenesis of ERILs and sought to investigate whether these biomarkers provide prognostic information on the risk of development of ERILs independently of clinical and imaging variables. METHODS: This prospective study enrolled 153 consecutive patients with acute ischemic stroke who underwent diffusion-weighted imaging within 24 hours and subsequently at 5 days after onset and whose plasma or serum for biomarkers (C-reactive protein, fibrinogen, d-dimer, tissue plasminogen activator, and plasminogen activator inhibitor-1) were collected within 24 hours of onset. Those receiving thrombolysis or interventional therapy were excluded. ERILs were defined as new ischemic lesions on 5-day diffusion-weighted imaging separate from the index stroke lesions, which were not accompanied by subsequent recanalization. RESULTS: ERILs were observed in 37 patients (24.2%). In univariate analysis, shorter time from onset to initial MRI (P=0.013), initial acute multiple infarcts (P<0.001), initial larger infarct volume (P=0.005), stroke subtype (P<0.001), elevated d-dimer (P=0.028), and anticoagulation after admission (P=0.001) were associated with ERILs. In multivariate analysis, initial acute multiple infarcts (OR, 16.60; 95% CI, 5.73 to 48.08), large artery atherosclerosis (OR, 4.62; 95% CI, 1.51 to 14.11), and log d-dimer (OR, 3.20; 95% CI, 1.14 to 9.00) remained independent predictors of ERILs. CONCLUSIONS: These data suggest that elevated d-dimer level reflecting increase of thrombin generation and fibrin turnover may be an independent factor predicting ERILs.

Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients.

OBJECTIVE: To determine whether changes in nutritional status in the first week after acute ischemic stroke and undernutrition predicts poor clinical outcomes. DESIGN: Prospective observational study. SETTING: Tertiary university hospital. PATIENTS: We included 131 acute ischemic stroke patients who underwent nutritional assessments within 24 hours and at 1 week after symptom onset. MAIN OUTCOME MEASURES: Undernutrition was diagnosed when 1 or more of the following 5 parameters were present: (1) weight loss 10% or more during the past 3 months or 6% or more during the week after admission, (2) a weight index less than 80%, (3) a serum albumin level less than 3.0 g/dL, (4) a transferrin level less than 150 mg/dL, or (5) a prealbumin level less than 10 mg/dL. We assessed poststroke complications and 3-month outcome using modified Rankin Scale responder analysis. RESULTS: Of 131 patients included in this study, undernutrition was observed in 16 (12.2%) patients at admission and in 26 (19.8%) at 1 week. Multiple logistic regression analysis showed that baseline undernutrition independently predicted 1-week undernutrition (odds ratio [OR], 14.85; 95% confidence interval [CI], 3.52-62.76; P< .001) and poststroke complications (OR, 6.72; 95% CI, 1.09-41.56; P= .04), and that 1-week undernutrition (OR, 4.49; 95% CI, 1.07-18.94; P= .04) and 1-week National Institutes of Health Stroke Scale score (OR, 1.76; 95% CI, 1.31-2.37; P< .001) independently predicted poor 3-month outcomes. CONCLUSIONS: These findings suggest that acute ischemic stroke patients with baseline undernutrition are being undernourished during hospitalization. Strategic nutritional support, particularly in patients with baseline undernutrition, may improve clinical outcomes.

Relationships among Lifestyle, Depression, Anxiety, and Reproductive Health in Female University Students.

PURPOSE: To identify relationships among lifestyle, psychological distress, and reproductive health in female university students. METHODS: We used a descriptive cross-sectional design. A total of 275 subjects were enrolled. Subjects agreed to undergo a face-to-face interview, including administration of structured questionnaires to determine health promotion lifestyle profile II (HPLP-II), depression anxiety stress scale for depression and anxiety (DASS-D, DASS-A), and reproductive health (knowledge, attitude, behavior, menstruation irregularity, dysmenorrhea, and gynecologic symptoms). RESULTS: The mean age of subjects was 21.2 years. Those with low HPLP-II score showed significantly high menstruation irregularity. Those with high depression and anxiety had significantly high reproductive symptoms. In addition, high HPLP-II score was correlated with low depression, anxiety, and high reproductive health. CONCLUSION: The life style of female university students is associated with depression, anxiety, and reproductive health. To improve female university students' reproductive health, life style interventions including healthy nutritional habit, physical activity, and stress management are important.

Early recurrent ischemic lesions on diffusion-weighted imaging in symptomatic intracranial atherosclerosis.

BACKGROUND: Prior observations have shown that early recurrent ischemic lesions (ERILs) on diffusion-weighted imaging occur frequently within the first week after an index stroke. OBJECTIVE: To investigate differential patterns of ERILs among stroke subtypes, particularly intracranial large-artery atherosclerosis (IC-LAA). DESIGN: Retrospective study. SETTING: Tertiary university hospital. PATIENTS: We included 133 patients who experienced an acute ischemic stroke and who underwent initial diffusion-weighted imaging within 24 hours and subsequent diffusion-weighted imaging within 7 days after onset, and whose stroke subtype was IC-LAA, extracranial LAA (EC-LAA), or cardioembolism (CE). MAIN OUTCOME MEASURE: Early recurrent ischemic lesions were defined as new ischemic lesions on follow-up diffusion-weighted imaging, separate from the index stroke lesion. RESULTS: Early recurrent ischemic lesions were observed in the following proportions: 50.9% (28/55) in the IC-LAA group, 47.4% (9/19) in the EC-LAA group, and 44.1% (26/59) in the CE group. Early recurrent ischemic lesions in the IC-LAA group had the following characteristics: (1) they occurred mostly (27 [96.4%] of 28) in the pial area of the same vascular territory as the index stroke; (2) they were more frequently observed in a higher grade of stenosis than in milder stenosis (P<.001), whereas ERILs in the EC-LAA group were not related to the degree of stenosis; (3) they were not associated with subsequent recanalization, whereas ERILs in the CE group were mostly associated with subsequent recanalization (P<.001); and (4) they were more closely associated with clinical recurrence than in the EC-LAA or CE group (P=.02). CONCLUSION: Early recurrent ischemic lesions in the IC-LAA group are relatively frequent and have different patterns than in the EC-LAA or CE group.

Influence of undernutrition at admission on clinical outcomes in patients with acute myocardial infarction.

BACKGROUND: Although the effect of overweight or obesity on clinical outcomes in patients with acute myocardial infarction (MI) has been reported, the effect of undernutrition is not as well understood. Therefore, we investigated whether acute MI patients frequently present with undernutrition, and whether this influences poor clinical outcomes. METHODS AND RESULTS: Using the Korea Acute Myocardial Infarction Registry database, we screened initial data on acute MI patients admitted within 48h of symptom onset to a tertiary university hospital between November 1, 2011 and May 31, 2015. We then assessed nutritional status at admission, using the Geriatric Nutritional Risk Index (GNRI). Of a total of 2251 patients, there were 1585 (70.4%) men, and mean age was 65.0±12.8 years. Based on GNRI score, undernutrition at admission was present in 409 (18.2%) patients. Multiple logistic regression analysis found undernutrition to be an independent factor influencing post-MI complications [odds ratio (OR), 2.13; 95% confidence interval (CI), 1.61-2.84; p<0.001], after adjusting for age, sex, hypertension, diabetes, hyperlipidemia, previous stroke, smoking, diagnosis, number of involved vessel lesions, Killip class, atrial fibrillation, baseline blood pressure, hemoglobin, creatine kinase-MB, creatinine, performance of percutaneous coronary intervention, reperfusion time, recanalization, and use of antithrombotics. Undernutrition was also an important factor influencing in-hospital death (OR, 2.48; 95% CI, 1.55-3.95; p<0.001), after adjusting for all potential factors by univariate analysis. CONCLUSIONS: Nutritional status is a significant prognostic factor in clinical outcomes after MI during hospitalization. Therefore, nutritional assessment and intervention, especially for undernourished MI patients, should be considered.

Differences in Type Composition of Symptom Clusters as Predictors of Quality of Life in Patients with Meningioma and Glioma.

OBJECTIVE: Objectives of this study were to identify and compare symptom clusters in patients with meningioma and glioma and to assess and compare predictors of quality of life (QoL) in both patient groups. METHODS: Data were collected using the MD Anderson Symptom Inventory-Brain Tumor Module, Functional Assessment of Cancer Therapy-General, and Karnofsky Performance Sale. Of 158 participating patients, 77 had meningioma, and 81 had glioma. RESULTS: In patients with meningioma, 4 symptom clusters were identified with 55.4% total variance: 1) physical, 2) cognitive, 3) elimination-appearance, and 4) motor-sensory symptoms. In patients with glioma, 4 clusters with 67.3% total variance were identified: 1) treatment-related, 2) cognitive, 3) appearance-elimination, and 4) gastrointestinal symptoms. Predictors of QoL in patients with meningioma were Karnofsky Performance Scale score (ß = 0.41, P < 0.001), cognitive symptom cluster (ß = -0.36, P < 0.001), and physical symptom cluster (ß = -0.32, P = 0.001), whereas treatment-related symptom cluster (ß = -0.55, P < 0.001) was identified as a predictor of QoL in patients with glioma. CONCLUSIONS: In this study, the type and composition of symptom clusters differed between patients with meningioma and glioma. Our data also provide evidence that even when participants reported mild symptoms, these clusters could be used to predict QoL in patients with meningioma and glioma.