The Influence of Traumatic Events on Turnover Intention among Nurses Working in Intensive Care Units: The Moderating Effect of Emotional Intelligence / 중환자간호학회지

Purpose@#: The purpose of this study was to identify the moderating effects of emotional intelligence on the relationship between traumatic events and turnover intention among nurses working in intensive care units (ICUs).Method : In this predictive correlation study, the convenience sample included 133 ICU nurses. Data were collected using an online, structured self-report survey. The collected data were analyzed by descriptive statistics, an independent t-test, an analysis of variance, Pearson’s correlation coefficient, and a hierarchical multiple regression analysis using SPSS/WIN 25.0. @*Results@#: The most frequently experienced traumatic events in ICUs were “nursing patients with abnormal behavior, including shouting and delirium,” “end-of-life care,” and “nursing patients with a risk of disease transmission, including AIDS and tuberculosis.” The moderating effect of emotional intelligence was found to be statistically significant on the relationship between traumatic events and turnover intentions (β=-0.15, p =.029). @*Conclusion@#: Intervention to improve the emotional intelligence of ICU nurses can be a salient strategy to reduce turnover intention resulting from traumatic events.

The Influence of Traumatic Events on Turnover Intention among Nurses Working in Intensive Care Units: The Moderating Effect of Emotional Intelligence / 중환자간호학회지

Purpose@#: The purpose of this study was to identify the moderating effects of emotional intelligence on the relationship between traumatic events and turnover intention among nurses working in intensive care units (ICUs).Method : In this predictive correlation study, the convenience sample included 133 ICU nurses. Data were collected using an online, structured self-report survey. The collected data were analyzed by descriptive statistics, an independent t-test, an analysis of variance, Pearson’s correlation coefficient, and a hierarchical multiple regression analysis using SPSS/WIN 25.0. @*Results@#: The most frequently experienced traumatic events in ICUs were “nursing patients with abnormal behavior, including shouting and delirium,” “end-of-life care,” and “nursing patients with a risk of disease transmission, including AIDS and tuberculosis.” The moderating effect of emotional intelligence was found to be statistically significant on the relationship between traumatic events and turnover intentions (β=-0.15, p =.029). @*Conclusion@#: Intervention to improve the emotional intelligence of ICU nurses can be a salient strategy to reduce turnover intention resulting from traumatic events.

Control of Inflammatory Responses: a New Paradigm for the Treatment of Chronic Neuronal Diseases

The term 'inflammation' was first introduced by Celsus almost 2000 years ago. Biological and medical researchers have shown increasing interest in inflammation over the past few decades, in part due to the emerging burden of chronic and degenerative diseases resulting from the increased longevity that has arisen thanks to modern medicine. Inflammation is believed to play critical roles in the pathogenesis of degenerative brain diseases, including Alzheimer's disease and Parkinson's disease. Accordingly, researchers have sought to combat such diseases by controlling inflammatory responses. In this review, we describe the endogenous inflammatory stimulators and signaling pathways in the brain. In particular, our group has focused on the JAK-STAT pathway, identifying anti-inflammatory targets and testing the effects of various anti-inflammatory drugs. This work has shown that the JAK-STAT pathway and its downstream are negatively regulated by phosphatases (SHP2 and MKP-1), inhibitory proteins (SOCS1 and SOCS3) and a nuclear receptor (LXR). These negative regulators are controlled at various levels (e.g. transcriptional, post-transcriptional and post-translational). Future study of these proteins could facilitate the manipulation of the inflammatory response, which plays ubiquitous, diverse and ambivalent roles under physiological and pathological conditions.

Change in Quality of Life according to the Change in Atopic Dermatitis Severity / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to longitudinally examine the correlation between the change of atopic dermatitis (AD) severity and the change of quality of life (QOL). METHODS: We assessed AD severity and QOL of patients and their families, by a prospective followed up for at least 12 months. AD severity was assessed, using the scoring of atopic dermatitis (SCORAD) index. A questionnaire based on dermatitis family impact (DFI), infants' dermatologic quality of life (IDQoL) and children's dermatology life quality index (CDLQI) were used to determine QOL. RESULTS: Seventy-nine AD patients were assessed for total and objective SCORAD and DFI. Among them, 45 patients that were less than 36 months old completed IDQoL and 13 patients that were equal to or more than 36 months old completed CDLQI. Objective SCORAD (oSCORAD) were correlated with DFI (r=0.235), IDQoL (r=0.602) and CDLQI (r=0.589) (P<0.05). At the 2nd interview, median oSCORAD (from 17.4 to 7.8), DFI (from 23.0 to 18.0) and IDQoL (from 9.0 to 6.0) were significantly decreased (P<0.01). The changes of oSCORAD were linearly related with the change of IDQoL (P<0.01), but neither with DFI (P=0.356) nor with CDLQI (P=0.267). Of the 64 patients with decreased oSCORAD, food allergy was accompanied more frequently in those with an increased DFI than those with a decreased DFI (60.7% vs. 27.8%, P<0.01). CONCLUSION: In this longitudinal study, the improvement of AD severity is correlated with the improvement of the patient's QOL, under the age of 3. To improve the family's QOL, we need to find out accompanying factors, such as food allergy, and to support the family accordingly.

The clinical effects of hospitalization in a low pollutant room on atopic dermatitis

BACKGROUND: Environmental pollutants are thought to be one of major triggers of atopic dermatitis (AD). OBJECTIVE: We attempted to evaluate the clinical effects of environment with low indoor pollutant levels on AD management. METHODS: Fifty-one children (mean age 1.7 years) with moderate to severe AD who failed to show improvement with conventional management were recruited. Disease severity was assessed by SCORAD (Scoring of AD) indices. They were admitted in a low pollutant oom for 3-4 days (mean 3.3 days) which was designed to keep low levels of dust, house dust mites, micro-organisms, and indoor air pollutants such as total volatile organic compounds (TVOCs), particulate matter (PM), and so on. Air pollutant levels in the low pollutant room were lower than primary standards defined by the Korean Ministry of Environment. we compared disease severity on admission and after discharge, and the pollutant levels of each patient's home and low pollutant room. RESULTS: The SCORAD was significantly reduced from 42.0 ± 11 .5 to 29.8 ± 8.9 (p < 0.001) by management in a low pollutant room. PM₂.₅, PM₁₀, formaldehyde, TVOCs, carbon dioxide, bacterial suspensions, and indoor molds were significantly higher in the patient's home than low pollutant room. Out of 29 patients who deteriorated after discharge to their home, 8 patients were admitted again, and their SCORAD was rapidly decreased from 53.1 ± 16.2 to 39.2 ± 9.8 (p = 0.036). CONCLUSION: Indoor air pollutants are likely to affect AD in susceptible individuals. Environmental control to lower indoor air pollutant levels might be necessary for better management of AD in some patients.

How Are Consumers, Service and Market Factors Related to Customer Loyalty in Medical Service?: Targeting the Medical Consumer in a City / 예방의학회지

OBJECTIVES: This study was performed to explore customer royalty and the related factors. METHODS: 900 households(a 1% sample) were randomly selected from the total population of K city located in Kangwon province. An interview survey was performed with using a structured questionnaire for the subjects(923 persons) who had used medical service during the year before the survey, and the survey was done September, 2002. RESULTS: When comparing the relating factors related with customer royalty according to the sociodemographic characteristics, the older group showed a significantly higher level of recognition for service quality, service reputation, internal customers.attitudes and switching cost. The lower income group showed a higher level of recognition for service quality, service image and switching cost. The lower educated group showed a higher level of recognition for service reputation, service image and internal customers.attitudes. The higher educated group showed a higher level of recognition for perceived risk, and seeking variety. In addition, the expert group or the service and manufacturing workers group showed a higher level of recognition for service involvement. On multiple regression analysis, internal customers' attitudes, service image, service reputation, service quality, switching cost, and substitutability showed significant relations with customer loyalty. CONCLUSIONS: This study showed that customer loyalty was significantly influenced by service factors like internal customers' attitudes, service image, service reputation, and service quality, and by market factors like switching cost, and substitutability. The results of this study can be used as a baseline for developing strategies to create and keep customers with high loyalty.

The Prevalence of Playing-Related Musculoskeletal Disorders of Music College Freshmen Playing String Instruments / 대한산업의학회지

OBJECTIVES: This study was conducted to investigate the prevalence of playing-related musculoskeletal disorders (PRMDs) of some music college freshmen majoring in string instruments. METHODS: The study subjects were 199 freshmen majoring in strings at three colleges in Seoul and surrounds. The symptom prevalence and related factors of PRMDs were surveyed with a self-administered questionnaire. The Southampton Protocol was used to diagnose PRMDs. RESULTS: The freshmen had played for 9 years and 7 months on average. The symptom prevalence of PRMDs according to the modified-NIOSH surveillance criteria was 73.4%. The shoulder was the most prevalent symptom complaint site. The prevalence of PRMDs by the Southampton Protocol was 54.3% and myofascial pain syndrome was the most common. The instrument (violin or viola vs. cello or bass), regular breaks, self perceived evaluation of playing posture and regular computer use had a significant association with the symptom prevalence of PRMDs in univariate logistic regression analysis (p<0.05). The instrument, regular breaks and regular computer use were significant variables affecting the symptom prevalence of PRMDs in multivariate logistic regression analysis (p<0.05). CONCLUSIONS: This study suggests that music college freshmen playing strings are a high risk group for musculoskeletal disorders. Therefore, the prevention of PRMDs requires the establishment of an ergonomic playing-environment, and the education of comfortable posture and stretching program such as musical warming up and physical stretching. It is especially important to form an effective treatment and rehabilitation system based on earlier diagnosis for musicians who are suffering from the PRMDs.

Acute Alcohol Intoxication in a Child

Information on ethyl alcohol intoxication in children is scarce. It is generally believed that children are more vulnerable to ethyl alcohol intoxication than adults. However, little information has been published on the effects of ethanol in the pediatric age group. The incidence of hypoglycemia and convulsions following ethanol intoxication is not known. We report a fatal case of acute alcohol intoxication associated with hypoglycemia, convulsion and coma.

A Case of Pure Red Cell Anemia Complicated by Antiepileptic Drugs

A 12-year-old boy developed pure red cell anemia(PRCA) during a combination therapy of antiepileptic drugs(AEDs) for epilepsy. His complex partial seizure was intractable to monotherapy. During 7 months of treatment, he was treated with Vigabatrin, Carbamazepine and Valproate. While switching from Carbamazepine to Valproate, he presented anemia but with no jaundice. His hemoglobin was 4.1g/dl bone-marrow biopsy revealed erythroid hypoplasia with normal myelopoiesis and megakaryocytopoiesis, indicating PRCA. Rapid recovery from PRCA was observed 1 month after discontinuation of Valproate, without immunosuppressive therapy. Although the hematologic toxicity of AEDs is well documented, isolated cessation of red cell production is uncommon. Our observation suggests that the synergistic toxicity caused by Valproate and Carbamazepine may induce PRCA through the inhibitory effect beyond the differentiation stage of BFU-E and CFU-E.

Effects of Thioredoxin on Apoptosis-Inducing Neuronal Cell Injury

PURPOSE: Thioredoxin is an endogenous antioxidant. It regulates the activities of transcriptional factors such as NF-kB(nuclear factor kappa B)and AP-1(activator protein-1) and it increases the synthesis of cytokines, preventing cellular proliferation and apoptosis. The aim of this study was to clarify the role of thioredoxin on apoptosis-inducing neuronal cell injury. We investigated the protective effects of thioredoxin against apoptosis-inducing neuronal cell injury through intracellular mechanism by 6-hydroxydopamine and serum deprivation. METHODS: PC 12 cells were cultured in RPMI 1640 media containing 10% fetal calf serum and subcultured in 96-well plates. Each well contained 30,000 cells. Cells were treated with hydrogen peroxide, diamide or 6-hydroxydopamine 30 minutes after thioredoxin treatment and then incubated for 24 hours. Cytotoxicity and cellular viability were assessed by measuring lactate dehydrogenase(LDH) release and MTT reduction. RESULTS: Thioredoxin increased cytotoxicity of PC cells treated with 6-hydroxydopamine by increasing LDH release and decreasing MTT reduction. In the serum deprivation condition, thioredoxin increased cytotoxicity of PC cells by increasing LDH release. CONCLUSION: Thioredoxin potentiates oxidative injury through intracellular mechanisms by 6-hydroxydopamine and serum deprivation instead of protecting. The cytotoxicity of thioredoxin may be mediated by decreasing the activity of NF-kB, which has been reported recently to protect against cellular apoptosis. Evidence suppors that the cytotoxic effect was not increased in the presence of serum in this study. Therefore, we found that the antioxidant effects of thioredoxin depended on mechanisms of injuries.

Non-typhoid Salmonella meningitis complicated by a infarction of basal ganglia

A previously healthy 16-month-old Korean girl with symptoms of fever, vomiting, and generalized tonic seizure was diagnosed to have Group D non-typhoid Salmonella meningitis. The patient was treated with ceftriaxone (100 mg/kg/day) and amikin (22.5 mg/kg/day) initially and ciprofloxacin (30 mg/kg/day) was added later because of clinical deterioration and disseminated intravascular coagulation. Brain CT performed on the second day showed a well-demarcated low density lesion in the right lentiform nucleus and both caudate nuclei, without evidence of increased intracranial pressure. MRI performed on the 11th day confirmed CT scan findings as well as right subdural fluid collection, brain atrophy, and ventriculomegaly. She underwent subdural drainage and later ventriculo-peritoneal shunt operation. Despite receiving intensive treatment, she still has severe neurologic sequelae. Our case shows that infarctions of basal ganglia and thalami are not specific for tuberculous meningitis and that meningitis complicated by infarction is indicative of grave prognosis.

Effects of Thioredoxin on Oxidative Neuronal Cell Injury

PURPOSE: Thioredoxin is an endogenous antioxidant which directly scavenges reactive oxygen species(ROS) and regenerates oxidatively damaged protein by reducing potential at the redox active disulfide(-Cys-Gly-Pro-Cys-) site. Under oxidative stress, thiredoxin plays a protective and adaptative role by inducing expressions. The aim of this study was to clarify the role of thioredoxin on oxidative neuronal cell injury. We investigated the protective effects of E. coli thioredoxin, also acting as a substrate for mammalian thioredoxin reductase, against oxidative neuronal cell injury under oxidative stresses such as hydrogen peroxide and diamide. METHODS: PC 12 cells were cultured in RPMI 1640 media containing 10% fetal calf serum and subcultured in 96-well plates. Each well contained 30,000 cells. Cells were treated with hydrogen peroxide or diamide 30 minutes after thioredoxin treatment and then incubated for 24 hours. Cytotoxicity and cellular viability were assessed by measuring of lactate dehydrogenase(LDH) release and MTT reduction. RESULTS: Thioredoxin not only decreased the cytotoxicity of PC 12 cell treated with hydrogen peroxide by decreasing LDH release and preventing the decrease of MTT reduction but also thioredoxin showed greater protective effects when simultaneously treated with hydrogen peroxide. Also, thioredoxin decreased cytotoxicity by decreasing LDH release from PC 12 cells damaged by diamide. Thioredoxin did not prevent the decrease of MTT reduction on PC 12 cells damaged by diamide. CONCLUSION: Thioredoxin protected PC 12 cells under oxidative stresses by directly scavenging and inhibiting oxidants such as hydrogen peroxide and diamide.

Seizure Types and EEG Findings of Juvenile Onset Idiopathic Generalized Epilepsy

PURPOSE: Juvenile myoclonic epilepsy, juvenile absence epilepsy, and epilepsy wth generalized tonic clonic seizure (GTCS) on awakening are the three syndromes of idiopathic generalized epilepsy of adolescent onset currently included in the classification of epilepsy syndromes of the International League Against Epilepsy (ILAE). Although they differ in their predominant seizure types, the syndromes share several seizure types. Also, there are no unique electrophysiologic or genetic markers. The question of phenotypic overlap and purity have arison. METHODS: We diagnosed 60 patients as idiopathic generalized epilepsy in Seoul National University Children's Hospital from August 1987 to June 1993 were analyzed in aspects of seizure types, electroencephalographic findings and follow up results. Their onset age of seizure was over 8 year old and the follow-up period was minimum 3 year. RESULTS: 1) seizure types : Four groups were defined by seizure type. The group with absence but not myoclonic (group A) were 19 cases (31.7%) and the group with myoclonic but not absence (group B), 12 cases (20.0%), the group with absence and myoclnic (Group C), 4cases (6.7%), and the group with GTCS only (Group D), 25 cases (41.6%). There was a tendency in that absence begins earlier and myoclonic seizure later in each group. 2) epilepsy syndromes : We could classify as 20 cases (33.3%) of jevenile absence epilepsy, 15 cases (15%) of jevenile myoclonic epilepsy, 5 cases (8.4%) of epilepsy with generalized tonic clonic on awakening, and 20 cases (33.3%) of isolated generalized tonic clonic seizure. 3) EEG characteristics by seizure type : 3-4Hz generalized bursts were most frequent in group A (p<0.05) and polyspike discharges were more frequent in group B than group A (p<0.05). The response to photic stimulation were more frequently observed in group B than group A. There was no significant differences in response to hyperventilation between group A and B. CONCLUSION: To define the combination of seizure types occurred in intervals make easy to approach the diagnosis and treatment of idiopathic generalized epilepsy syndromes. We found that the current classification does not include all patients such as isolated generalized tonic clonic seizure in this study. We can expect information from the fields of molecular genetics and neuroimaging to help to define the etiologic basis of many epilepsies and perhaps to refine the present system of classification, more etiologically oriented and disease-specifically.

Predictor of Fatty Liver in Obese Children

PURPOSE: The childhood obesity is currently increasing. The childhood obesity is difficult to treat and the response of treatment is transitory because it is caused by the hyperplasia of fat cells. The complications of obesity are hyperlipidemia, hypertension, diabetes, artherosclerotic coronary arterial disease and fatty liver. Therefore the early diagnosis and prevention of obesity from childhood is very important. This study was performed to identify the relation between various weight-height indices and serum lipid levels and to seek for the parameters predicting the presence of fatty liver in obese children. METHODS: Between January 1994 to August 1995, 145 children were diagnosed as obesity by height-weight indices or fat % calculated from skin fold thickness among 672 children who were take an health care services at Ewha Womans University Hospital. Thirteen children of them were complicated with fatty liver. Serum lipid levels and abdominal ultrasonography were performed in 145 obese children. RESULTS: Most obese children were 9-13 years of age. The obese children with fatty liver(85.0%) have larger proportion of moderate to severe obesity than those without fatty liver(30.3%). The analysis of height-weight indicies(obesity index, Rohrer index, body mass index) and serum lipid levels revealed that total cholesterol level highly related to RI(r=0.937) and BMI(r=0.805). There are statistically significant differences in height-weight indices between obese children with fatty liver and without fatty liver (p<0.05). There are statistically significant differences in triglyceride level and HDL cholesterol(p<0.05), not in total cholesterol and LDH cholesterol between both groups. The grade of fatty liver is significantly related to serum triglyceride level(r=0.45, p<0.05). CONCLUSIONS: The incidence of fatty liver was significantly associated with the degree of obesity and serum triglyceride level. Therefore, the serum triglyceride level is a good parameter to predict fatty liver in moderate to severe obese children.

The Usefulness of Clinical Scoring System as Prognostic Predictor in Neonatal Seizure

PURPOSE: Neonatal seizure is usually the presentation of underlying neurologic dysfunction rather than a disease and have high mortality and morbidity as sequalae. Therefore, the parameter predicting the neurologic prognosis is necessary. This study was performed to identify the usefulness of clinical scoring as predictor in neonatal seizure by analyzing outcomes. METHODS: From 1982 to 1994, 101 neonates were admitted to Neonatal Intensive Care Unit(NICU) of Ewha Womans University Tong Dae Mun Hospital due to neonatal seizure and their medical records were reviewed. The follow-up data were reviewed in only 43(42.6%)patients. We scored five clinical manifestations including birth weight, etiology, type of seizure, duration of seizure and neurologic examinations at seizure and differentiated the follow-up data into favorable outcome(normal) and unfavorable outcome(neurologic abnormality, delayed development, frequent seizure, death, or hopeless discharge). RESULTS: 1) Clinical manifestation: Most patients(81.2%) were full term. Seizure of most patients(88.1%) including all very low birth weight infants occured within seven day of age. The etiology of seizure were early hypocalcemia 29 cases(28.7%), severe hypoxia 26 cases(25.8%), electrolyte abnormality 13 cases(12.9%), septicemia 10 cases(9.9%), SAH or SDH 9 cases (8.9%) and hypoglycemia 9 cases(8.9%). The type of seizure were 61 cases(60.4%) of tonic type, 24 cases(23.8%) clonic type, 15 cases(14.8%) of subtle seizure, and 1 case of myoclonic seizure who had holoprosencephaly. The duration of seizure were 49 cases(48.5%) of repetitive brief, 34 cases(33.7 %) of more than 60 sec and 18 cases of single brief. The neulologic findings at seizure showed that 47 cases(46.5%) were normal, that 40 cases(39.6%) were markedly abnorml and that 10 cases(9.9%) were mildly abnormal. 2) The validity of clinical scoring to unfavorable outcome showed 90.9% of sensitivity, 47.6% of specificity, 64.5 of positive predictive value, and 83.3 of negative predictive value when the cut-off point of scores was 4. 3) The birth weight, the duration of seizure and neurologic findings at seizure were good parameters predicting unfavorable outcome (p< 0.05). CONCLUSIONS: The clinical scoring had high sensitivity and high negative predictive value as prognostic predictor. Especially, the birth weight, the duration of seizure, and neurologic finding at seizure were useful items.

Auditory Brainstem Responses in Premature and Fullterm Infants

No abstract available.