Comparative pharmacokinetics between tenofovir disoproxil phosphate and tenofovir disoproxil fumarate in healthy subjects

Tenofovir is the representative treatment for human immunodeficiency virus and hepatitis B virus infection. This study was conducted to assess the pharmacokinetics (PKs) and safety characteristics after a single administration of tenofovir disoproxil phosphate compared to tenofovir disoproxil fumarate in healthy male subjects. An open-label, randomized, single administration, two-treatment, two-sequence crossover study was conducted in 37 healthy volunteers. Serial blood samples were collected up to 72 hours. Non-compartmental analysis was used to calculate the PK parameters. The 90% confidence intervals (90% CIs) of the geometric mean ratio (GMR) were calculated for comparing tenofovir disoproxil phosphate to tenofovir disoproxil fumarate. Safety assessments were performed including clinical laboratory tests, adverse events, etc. during the study. The GMR and 90% CIs were 1.0514 (0.9527–1.1603) for C max and 1.0375 (0.9516–1.1311) for AUC last , respectively, and both fell within the conventional bioequivalence range of 0.8–1.25. Both tenofovir salt forms were tolerable. This study demonstrated that tenofovir disoproxil phosphate (292 mg) was bioequivalent to tenofovir disoproxil fumarate (300 mg).

Child-rearing experiences of mothers with early adolescents in Korean multicultural families

Purpose@#This study was conducted to explore the child-rearing experiences of mothers with early adolescents in Korean multicultural families. @*Methods@#The participants were six mothers with early adolescents in Korean multicultural families. Data were collected through in-depth interviews. The main question was, "Could you tell me about your child-rearing experiences with your adolescent child?" The data were analyzed using qualitative content analysis. @*Results@#Four categories resulted from the analysis of child-rearing experiences of mothers with early adolescents in Korean multicultural families, as follows: "separation between myself and others", "distance between myself and my adolescent child", "making efforts to bridge the gap between myself and others", and "trying to connect with my adolescent child closely". @*Conclusion@#These findings indicate that mothers in Korean multicultural families made many efforts to bridge the gap between themselves and other people, and tried to connect with their children closely. The findings of this study emphasize specific aspects of how mothers with early adolescents experienced child-rearing in Korean multicultural families.

Knowledge on Sudden Unexplained Infant Death-related Safe Sleep Practices and Infant Cardiopulmonary Resuscitation in Pediatric Nurses

Purpose@#Sudden unexplained infant death (SUID) is a major contributor to infant mortality, and pediatric nurses have the responsibility to educate parents on SUID-reducing strategies. This study was conducted to measure pediatric nurses' knowledge of SUID-related safe sleep practices (K-SSSP) and infant cardiopulmonary resuscitation (K-ICPR). @*Methods@#In total, 136 pediatric nurses were administered a survey including K-SSSP (13 items), K-ICPR (5 items), confidence in K-SSSP education (1 item; 5 points), and other factors relating to SUID experiences or education. @*Results@#The correct answer rates of the K-SSSP and K-ICPR were 62.6% and 62.5%, retrospectively. The mean score for confidence in K-SSSP education was 2.6±0.9. Only 18 nurses (13.2%) responded that they educated parents on the content of the K-SSSP, while 76 nurses had received education on SUID. Positive relationships were observed between K-SSSP scores and higher education, between K-ICPR scores and having own child(ren) and clinical experience, and between confidence in K-SSSP education and higher education or having one's own child(ren). Nurses caring for newborns performed more SUID education than nurses working in other units. @*Conclusion@#There is a profound need to implement a systemic educational program on SUID and strategies to reduce SUID for pediatric nurses.

Factors Affecting Health Behaviors in Late School-aged Children from Multicultural Families

Purpose@#This study was conducted to investigate factors affecting health behaviors in late school-aged children from multicultural families. @*Methods@#This study included 401 children (112 from multicultural families and 289 from non-multicultural backgrounds) in grades 4~6 in 11 elementary schools. Data on health behaviors and related factors (school adjustment, the mother-child relationship, self-efficacy, etc.) were collected from the children using self-reported questionnaires between May and June in 2019. The collected data were analyzed through a univariate analysis and multiple regression analysis. @*Results@#The health behavior score of multicultural children was lower than that of non-multicultural children (t=3.32, p=.001). In multicultural children, school adjustment (β=.55, p<.001), mother-child relationship (β=.25, p=.001), and perceived health status (very healthy=1; β=.19, p=.011) were significant factors affecting their health behavior and explained 47.0% (F=30.93, p<.001) of the variance. @*Conclusion@#Multicultural late school-aged children are at risk to engage in a lower level of health behaviors than their non-multicultural counterparts. More attention should be paid to ways of improving multicultural children’s perceptions of their health status, maternal relationships, and school adjustment in order to promote health behaviors.

Framingham risk score and risk of incident chronic kidney disease: A community-based prospective cohort study

BACKGROUND: Cardiovascular disease and chronic kidney disease share several common risk factors. The Framingham risk score is hypothesized to predict chronic kidney disease development. We determined if the Framingham risk scoring system can correctly predict incident chronic kidney disease in the general population. METHODS: This study included 9,080 subjects who participated in the Korean Genome and Epidemiology Study between 2001 and 2014 and had normal renal function. The subjects were classified into low- ( 20%) risk groups based on baseline Framingham risk scores. The primary endpoint was de novo chronic kidney disease development (estimated glomerular filtration rate [eGFR], < 60 mL/min/1.73 m²). RESULTS: During a mean follow-up duration of 8.9 ± 4.3 years, 312 (5.3%), 217 (10.8%), and 205 (16.9%) subjects developed chronic kidney disease in the low, intermediate, and high risk groups, respectively (P < 0.001). Multivariable analysis after adjustment for confounding factors showed the hazard ratios for the high- and intermediate risk groups were 2.674 (95% confidence interval [CI], 2.197–3.255) and 1.734 (95% CI, 1.447–2.078), respectively. This association was consistently observed irrespective of proteinuria, age, sex, obesity, or hypertension. The predictive power of this scoring system was lower than that of renal parameters, such as eGFR and proteinuria, but increased when both were included in the prediction model. CONCLUSION: The Framingham risk score predicted incident chronic kidney disease and enhanced risk stratification in conjunction with traditional renal parameters in the general population with normal renal function.

Incidence of Acute Kidney Injury after Adrenalectomy in Patients with Primary Aldosteronism

BACKGROUND@#Aldosterone-induced glomerular hyperfiltration can lead to masked preoperative renal dysfunction in primary aldosteronism(PA) patients. We evaluated whether PA patients had a higher prevalence of acute kidney injury (AKI) after unilateral adrenalectomy. In addition, we identified risk factors for AKI in these subjects.@*METHODS@#This retrospective study included 107 PA patients, and 186 pheochromocytoma patients as a control group, all of whom underwent adrenalectomy between January 2006 and November 2017 at Yonsei University Severance Hospital. The primary outcome was AKI within 48 hours after adrenalectomy. Univariate and multivariate logistic regression analyses were performed to identify predictors of AKI after adrenalectomy.@*RESULTS@#Overall incidence of AKI was 49/293 (16.7%). In PA patients, the incidence of AKI was 29/107 (27.1%). In contrast, incidence of AKI was 20/186 (10.7%) in pheochromocytoma patients. Univariate and multivariate logistic regression analysis both showed a higher risk of postoperative AKI in PA patients compared to pheochromocytoma patients. In addition, old age, diabetes, longer duration of hypertension, lower preoperative estimated glomerular filtration rate, high aldosterone-cortisol ratio (ACR) and lateralization index (LI) were identified as independent risk factors for postoperative AKI in PA patients after unilateral adrenalectomy.@*CONCLUSION@#Incidence and risk of postoperative AKI were significantly higher in PA patients after surgical treatment. High ACR on the tumor side and high LI were associated with higher risk of AKI in PA patients compared to pheochromocytoma patients.

Cognitive Ability and Related Factors in Preschoolers Born Prematurely

PURPOSE: This study was conducted to evaluate cognitive ability in preschoolers born prematurely and to investigate related factors.METHODS: A prospective, longitudinal study was conducted with 64 children at 5–6 years of corrected age (CA) (second follow-up) among 76 children who had been assessed at 2.0~3.5 years of CA (first follow-up) from a sample of 343 preterm infants born from 2008 to 2010. To evaluate each child's cognitive ability, during a home visit, we used the Kaufman Assessment Battery for Children-II (KABC-II) at the second follow-up. To explore factors related to cognitive ability, we measured children's hemoglobin level at the second follow-up and used the data collected in our previous study, including the Bayley Scale of Infant Development-II (BSID-II) at the first follow-up.RESULTS: The mean total KABC-II quotient was 117.0±14.4. The 5-minute Apgar score (β=.29, p=.006), hemoglobin level (β=.22, p=.032), and the mental development index quotient of the BSID-II (β=.51, p<.001) were statistically significant predictors of the KABC-II quotient in multiple linear regression analysis.CONCLUSION: The cognitive function of young children born prematurely was influenced by early neurodevelopment and factors reflecting their health status, such as anemia and a low 5-minute Apgar score.

Adiposity Measurements and Related Characteristics of Young Children Born Prematurely

PURPOSE: This study was conducted to measure adiposity and to investigate related factors in preschoolers born prematurely. METHODS: A longitudinal follow-up study was conducted with 52 preschoolers at 5 years of corrected age among 343 preterm infants. Their adiposity status was evaluated based on measurements of body mass index, subscapular and triceps skin fold thickness (SFT), waist circumference, waist-to-height ratio, and mid-arm circumference at a home visit. RESULTS: The findings showed that SFT measurements, particularly at the triceps, reflected the degree of adiposity more accurately than other conventional measures. A shorter gestation, older maternal age, and the mother having more years of formal education were associated with higher levels of adiposity in the preschoolers. CONCLUSION: The adiposity of children born prematurely needs to be thoroughly monitored with additional SFT measurements, considering the risk of accelerated growth patterns overriding regular catch-up growth in children born prematurely.

Hydration and pH of the Stratum Corneum in High-risk Newborns in the First 2 Weeks of Life

PURPOSE: The study was conducted to measure stratum corneum hydration (SCH) and pH (SCP) in high-risk newborns in the early postnatal period and to explore the features related to patterns of change in those parameters. METHODS: SCH and SCP were measured on the dorsal hand in 99 hospitalized newborns during the first 14 days of life and the results were analyzed using a general linear model. RESULTS: The mean hydration was 42.9% on day 1, which decreased to 34.6% by 2 weeks (F=15.61, p= < .001). An association was observed between SCH and prematurity (F=21.12, p < .001), as well as for their interaction (F=8.11, p < .001). The mean SCP was 6.2±0.3 on day 1, and decreased to 5.7±0.2 (F=95.75, p < .001), with no association with prematurity. After adjusting for birth weight, SCH was higher in newborns with vaginal delivery (F=9.07, p=.023) and who received phototherapy (F=11.81, p=.011). For SCP, only delivery type had a significant influence (F=6.40, p=.044). CONCLUSION: This study suggests that SCH is typically in the 30% range during the early postnatal period, and that an acid mantle on the SC surface is very unlikely to form; these findings could be applied to the nursing process for promoting skin integrity in high-risk neonates.

Influence of Uncertainty and Uncertainty Appraisal on Quality of Life in Prostate Cancer Patients after Prostatectomy

PURPOSE: The purpose of this study was to determine the impact of uncertainty and uncertainty appraisal on quality of life (QoL) among prostate cancer patients after prostatectomy. METHODS: A descriptive correlational study was conducted with 117 participants at a hospital in S city from October 1 to December 31, 2016. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients and stepwise multiple regression using the IBM SPSS/WIN 21.0 program. RESULTS: According to a multiple regression model of the factors affecting QoL among prostate cancer patients after the operation, 61% of variance (F=13.92, p<.001) was explained by metastasis, recurrence, monthly income, uncertainty, uncertainty danger appraisal, and uncertainty opportunity appraisal. And the most influential factor in the QoL was uncertainty danger appraisal (β=-.37, p<.001). CONCLUSION: This study demonstrated that QoL was influenced by uncertainty, uncertainty appraisal and personal characteristics. Prostate cancer patients following prostatectomy should be provided with tailored training to improve their uncertainty opportunity appraisal. Also the educational program for reducing their uncertainty should be developed and provided to patients.

Factors Influencing Parenting Stress in Mothers of Preschoolers Born Prematurely

PURPOSE: This study was conducted to describe parenting stress in mothers of preschoolers who were born prematurely and to determine factors affecting parenting stress in child's problem behavior, mother-child interaction and parenting alliance. METHODS: An exploratory survey study was conducted with 66 mothers of preschool children (5~6 years) with preterm births (PTB). Data were collected using Parenting Stress Index (PSI), Child Behavior Checklist (CBCL), Mother-Preschool Child Interaction Scale (MPIS), and Parenting Alliance Inventory (PAI). RESULTS: Of the 66 mothers, 8(12.1%) showed high scores that were more than borderline for the PSI total score. In the multiple linear regression analysis, lower scores on the PAI (β=−.41, p<.001), higher scores on the externalizing problem behavior of the CBCL (β=.40, p=.001), and lower scores on the MPIS (β=−.21, p=.043) were statistically significant contributors to maternal parenting stress. CONCLUSION: Findings indicate that mothers of PTB preschool children are at risk for parenting stress. Child's externalizing problem behavior, poor maternal-child interaction and parenting alliance were independent factors raising maternal parenting stress. More attention is needed on paternal parenting support, child's behavioral development, interaction with children for effective prevention and management of maternal parenting stress of PTB young children.

Health in Optimal Fitness and its Related Factors in Young Korean Children Born Prematurely

PURPOSE: This study was conducted to describe health in optimal fitness (HOF) in young children born prematurely and to analyze factors affecting HOF in health status, investment resources, and anthropological values, based on HOF theory. METHODS: A case-control study of 76 children with preterm births (PTB) was conducted at 24 to 42 months of corrected age. Their HOF status was evaluated based on height, weight, head circumference, and the Korean-Bayley Scale of Infant Development-II and classified as either HOF-achieved or HOF-uncertain in the domain of growth, development, and all together. RESULTS: For growth, development, and all, 26.3%, 27.6%, and 47.4% of children, respectively, belonged to the HOF-uncertain group. Logistic regression analysis showed that longer length of hospital stay (≥21days; OR=7.8; 95% CI [1.5, 40.5]), worse scores on the Home Observation for Measurement of the Environment (HOME) (≥38; OR=0.1; 95% CI [0.0, 0.4]), having a working mother, (OR=5.7; 95% CI [1.2, 27.6]), and an older mother (≥35 years; OR=8.8; 95% CI [2.1, 37.3]) were statistically significant contributors of HOF-uncertain in the domain of all. CONCLUSION: Findings show that young children born prematurely with prolonged stays in a neonatal intensive care unit and insufficient socioeconomic resources at home are more likely to exhibit delayed growth and development.

Related Factors for Behavioral Problems in Toddlers Born Prematurely

PURPOSE: The study was done to investigate behavioral problems in toddlers who were born prematurely and to analyze related factors. METHODS: A cross-sectional explorative study was conducted with 72 preterm birth (PTB) children at 24 to 41 months of corrected age who were born at 28 to 37 weeks' gestation. During home visits, behavior problems were assessed using the Behavior Rating Index for Children (BRIC). Using a BRIC score of > or =30, children with suspected behavior problems were grouped in the non-regular behavior group. RESULTS: Of the children, 38.9% belong to the non-regular behavior group. The mental development index score for the Korean-Bayley Scale of Infant Development-II was higher for the non-regular behavior group compared to the regular behavior group (t=2.26, p=.027). Logistic regression analysis showed that lower maternal attachment ( or =97, OR=4.8, 95% CI[1.3, 17.3]) were independently related to non-regular behavior. CONCLUSION: PTB Toddlers are at risk for behavior problems which are associated with low cognitive performance. Maternal-child attachment and maternal parenting stress were strongly related to behavior problems in these children. More attention is needed to understand possible behavior problems in young children with PTB, particularly focusing on maternal-child interaction and maternal mental well-being.

Comparative analysis of oncologic outcomes for open vs. robot-assisted radical prostatectomy in high-risk prostate cancer

PURPOSE: To evaluate the oncologic outcomes of robot-assisted radical prostatectomy (RARP) in high-risk prostate cancer (PCa), we compared the surgical margin status and biochemical recurrence-free survival (BCRFS) rates between retropubic radical prostatectomy (RRP) and RARP. MATERIALS AND METHODS: A comparative analysis was conducted of high-risk PCa patients who underwent RRP or RARP by a single surgeon from 2007 to 2013. High-risk PCa was defined as clinical stage> or =T3a, biopsy Gleason score 8-10, or prostate-specific antigen>20 ng/mL. Propensity score matching was performed to minimize selection bias, and all possible preoperative and postoperative confounders were matched. A Kaplan-Meier analysis was performed to assess the 5-year BCRFS, and Cox regression models were used to evaluate the effect of the surgical approach on biochemical recurrence. RESULTS: A total of 356 high-risk PCa patients (106 [29.8%] RRP and 250 [70.2%] RARP) were included in the final cohort analyzed. Before adjustment, the mean percentage of positive cores on biopsy and pathologic stage were poorer for RRP versus RARP (p=0.036 vs. p=0.054, respectively). The unadjusted 5-year BCRFS rates were better for RARP than for RRP (RRP vs. RARP: 48.1% vs. 64.4%, p=0.021). After adjustment for preoperative variables, the 5-year BCRFS rates were similar between RRP and RARP patients (48.5% vs. 59.6%, p=0.131). The surgical approach did not predict biochemical recurrence in multivariate analysis. CONCLUSIONS: Five-year BCRFS rates of RARP are comparable to RRP in high-risk PCa. RARP is a feasible treatment option for high-risk PCa.

pH, Temperature, Hydration of the Stratum Corneum of the Dorsal Hand and the Cord Area, and Acid Mantle Formation during Early Days of life in High-risk Newborns

PURPOSE: The study was done to explore variations in physiologic parameters of the stratum corneum (SC) of the dorsal hand and cord area during early days of life in high-risk newborns. METHODS: In this longitudinal study, a total of 77 high-risk newborns were assessed for pH, temperature and hydration of the SC of the dorsal hand and the cord area on the 1st, 2nd, 3rd, 5th and 7th days of life. RESULTS: Results showed that an acid mantle (AM) was formed in 57.1% for dorsal hand and 35.1% for cord area, implying significant delay regardless of decrease in pH (F=103.60, p<.001), and hydration (F=4.00, p=.003) across days in both areas. Peripheral hypothermia with low hydration level was also observed in both areas. There was a positive relation between hydration and temperature (.14

Growth Patterns of Premature Infants Up to 40th Term Week of Corrected Age

PURPOSE: Study purpose were to describe growth patterns of premature infants in weight, length and head circumference from birth to 40th week of corrected ages (CA) and to explore factors affecting patterns. METHODS: A longitudinal descriptive study was conducted with 267 premature infants. They were categorized into 2 groups; GA group with measurements at birth and the CA group with measurements at CA, which was categorized into 3 groups (group 1-3) by WHO guideline for gestational age (GA) at birth. RESULTS: GA group presented greater measures in all than CA group at same week of life. Among CA groups, group 3 showed the highest measurements, up to 37 weeks of life, though this disappeared at 38-40 weeks. Reversely, group 1 revealed the highest growth rates in all measures, followed by group 2 and group 3. Significant interaction was observed in all measures between week of life and any type of groups. CONCLUSION: Higher measures in GA group, as well group 3 among CA groups, supported the superiority of intra-uterine environment overriding quality of regimen from NICU. Regardless of growth acceleration, smaller infants remain smaller, indicating that intra-uterine thrifty phenotype may continue at least up to the 40th week of CA.