The Pittsburg Sleep Quality Index (PSQI) and Associated Factors in Middle-school Students: A Cross-sectional Study

Purpose@#The purpose of this study was to evaluate the current level of sleep quality among Korean middle-school students using the Pittsburg Sleep Quality Index (PSQI), and to analyze the factors influencing sleep quality. @*Methods@#The study used a descriptive cross-sectional design and a self-report questionnaire. The participants were 744 middle-school students. The questionnaire included the PSQI and health-related questions, such as the types of diseases they had been diagnosed with and the frequency of hospital admissions. The data were analyzed using the independent t-test, analysis of variance, Pearson correlation coefficients, and linear multiple regression. @*Results@#The global PSQI score was 4.21, which indicated good sleep quality. The major factors that were associated with the sleep quality of middle-school students were the number of diseases they had been diagnosed with (β=.54, p=.001) and atopic dermatitis (β=.32, p=.001). In addition, asthma and the frequency of hospital admissions were significant factors influencing each component of the PSQI. @*Conclusion@#The findings from this study suggest that sleep quality was associated with several health-related factors. Thus, nurses, school nurses, and nursing researchers may need to assess the health-related factors associated with adolescents’ sleep quality as part of efforts to improve their sleep quality.

Factors Influencing eHealth Literacy of Middle School Students in Korea: A Descriptive Cross-Sectional Study / 대한의료정보학회지

OBJECTIVES: The aim of this study is to identify eHealth literacy level and to analyze the factors influencing eHealth literacy among middle school students in Korea. METHODS: This descriptive cross-sectional study involved the administration of a self-report questionnaire. The participants were 799 middle school students. Descriptive statistics were analyzed via an independent t-test, Mann-Whitney U-test, and one-way ANOVA. Pearson correlation coefficients were used to test the correlations among variables. Multiple linear regression analysis was conducted to identify the factors influencing eHealth literacy. RESULTS: eHealth literacy was substantially lower in students in their first year than in students in their third year of middle school. Participants with asthma, herniated disc, and atopic dermatitis had significantly lower eHealth literacy than those without the diseases. The major finding was that eHealth literacy of middle school students was influenced by their grade and number of diseases diagnosed. eHealth literacy was higher among students in their second and third years of middle school and among those who had fewer diagnosed diseases. CONCLUSIONS: eHealth literacy among adolescents is important for better health outcomes; however, middle school students with diseases had lower eHealth literacy than healthy students. Therefore, efforts to enhance eHealth literacy should focus on adolescents with diseases; moreover, health education in schools and healthcare settings for adolescents should include critical analytical skill development for better eHealth literacy.

Effects of Flipped Learning Using Online Materials in a Surgical Nursing Practicum: A Pilot Stratified Group-Randomized Trial / 대한의료정보학회지

OBJECTIVES: This study examined the effect of flipped learning in comparison to traditional learning in a surgical nursing practicum. METHODS: The subjects of this study were 102 nursing students in their third year of university who were scheduled to complete a clinical nursing practicum in an operating room or surgical unit. Participants were randomly assigned to either a flipped learning group (n = 51) or a traditional learning group (n = 51) for the 1-week, 45-hour clinical nursing practicum. The flipped-learning group completed independent e-learning lessons on surgical nursing and received a brief orientation prior to the commencement of the practicum, while the traditional-learning group received a face-to-face orientation and on-site instruction. After the completion of the practicum, both groups completed a case study and a conference. The student's self-efficacy, self-leadership, and problem-solving skills in clinical practice were measured both before and after the one-week surgical nursing practicum. RESULTS: Participants' independent goal setting and evaluation of beliefs and assumptions for the subscales of self-leadership and problem-solving skills were compared for the flipped learning group and the traditional learning group. The results showed greater improvement on these indicators for the flipped learning group in comparison to the traditional learning group. CONCLUSIONS: The flipped learning method might offer more effective e-learning opportunities in terms of self-leadership and problem-solving than the traditional learning method in surgical nursing practicums.

Effects of My Child's Safety Web-Based Program for Caregivers of Children with Cancer in South Korea / 대한의료정보학회지

OBJECTIVES: The purposes of this study were to develop a Web-based education program, My Child's Safety, which includes patient safety education and information on the diagnosis, treatment, and management for caregivers of children with cancer, and to examine the efficacy of the My Child's Safety program in promoting the caregivers' awareness of patient safety. METHODS: A one-group pre- and post-test design was adopted. The participants were the caregivers of children with cancer and were recruited from one pediatric hemato-oncology unit of a tertiary university hospital in a large metropolitan city of South Korea. They were asked to review the Web-based program for patient safety and then complete questionnaires developed to measure the awareness of patient safety among the caregivers. RESULTS: In the study, the total score of the caregivers' awareness of patient safety had increased significantly after Web-based self-learning patient safety education. Also caregivers' awareness of their right to ask and know about procedures and treatments during hospitalization had increased after the program was used. CONCLUSIONS: The Web-based patient safety education program effectively improved the awareness of patient safety and the awareness of the right to know and ask about procedures and treatments during hospitalization among the caregivers. Family caregivers were less likely to ask healthcare professionals questions related to safety.

Penile Expression of Nitric Oxide Synthase Isoforms in the Type II Diabetic Rat / 대한남성과학회지

PURPOSE: Erectile dysfunction commonly occurs in men with diabetes mellitus. Nitric oxide synthase (NOS) is essential for regulation of penile erection, and the isoforms of NOS have significance in a variety of complications of diabetes. However, little is known about the localization, abundance, and changes in NOS in diabetes. Therefore, we characterized the localization and abundance of NOS isoforms and explored their relationships and how they are altered in diabetes. MATERIALS AND METHODS: The Otsuka Long-Evans Tokushima Fatty (OLETF) rat, which models type II diabetes mellitus, and the non-diabetic control Long-Evans Tokushima Otsuka (LETO) rat were used. We analyzed the distribution of NOS isoforms in the isolated corupus cavernosum of both LETO and OLETF rats by immunohistochemistry (IHC). The mRNA expression of NOS isoforms was also analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: The concentration of nitrite/nitrate in cavernosal homogenate was higher in diabetic rats than non-diabetic rats, but the difference was not statistically significant. There was a reduction of immunoreactivity for nNOS and eNOS as well as nNOS and eNOS mRNA expression (p<0.05) in diabetic rats, compared to non-diabetic rats. In contrast, the IHC stain showed that iNOS increased in both the endothelium and vascular smooth muscle in the diabetic rats, and the mRNA expression of iNOS gene was also up-regulated (p<0.05). CONCLUSIONS: Change in the activity levels of NOS isoforms within the corpus cavernosum could be a major source of pathogenesis of erectile dysfunction in diabetes mellitus.

The Relationship between Serum Total Testosterone and Clinical Symptoms of Late-onset Hypogonadism in Aging Males / 대한남성과학회지

PURPOSE: Late-onset hypogonadism(LOH) in the aging male is a clinical and biochemical syndrome characterized by a decline in levels of serum testosterone, and results in various physical and mental disabilities. We aim to evaluate the relationship between serum testostosterone levels and symtpoms of LOH. MATERIALS AND METHODS: As part of an andropause screening program, we examined ADAM questionnaires, IIEF-5 scores, and total serum testosterone levels among healthy volunteers aged over 40 years. RESULTS: The mean age of the 409 men was 59.8 years(range 40~89), and the mean serum testosterone level was 471.5+/-180.2 ng/dl. The serum testosterone level decreased significantly in correlation with age. There was a 92.5% positive response on the ADAM questionnaire. Among patients whose serum testosterone was less than 350 ng/dl, the ADAM questionnaire was positive in 23.7%(n=97). The mean serum testosterone level for men with a positive or negative ADAM questionnaire was 469.2+/-181.8 or 489.2+/-170.5 ng/dl, respectively; this difference was not statistically significant (p=xxx). There was also no significant correlation between IIEF-5 scores and serum testosterone levels. CONCLUSIONS: Among men over 40 years of age, 23.7% met the clinical and biochemical diagnostic criteria for late-onset hypogonadism, and there was no relationship between serum testosterone levels and symptoms of late-onset hypogonadism.

Penile Expression of Hypoxia-inducible Factor-1alpha, Vascular Endothelial Growth Factor, and Nitric Oxide Synthase in the Type II Diabetic Rat / 대한남성과학회지

PURPOSE: Erectile dysfunction(ED) is commonly experienced in men with diabetes mellitus. Hypoxia in the penile tissue by vascular complications is regarded as a pathophysiologic factor in diabetic ED. The aim of this study is to investigate whether HIF-1alpha is altered in diabetic penile tissues and whether its alteration may modulate penile expression of VEGF and NOS, which are believed to play a role in diabeteic ED. MATERIALS AND METHODS: OLETF rats, an animal model for type II diabetes mellitus, and LETO rats, a non-diabetic control group, were used. We analyzed the distribution of HIF-1alpha, VEGF, and NOS(eNOS and iNOS) in the isolated corupus cavernosum of both LETO and OLETF rats by immunohistochemicalstaining. The mRNA expression levels of HIF-1alpha, VEGF, eNOS, and iNOS were also analyzed by reverse transcriptase-polymerase chain reaction(RT-PCR). RESULTS: There was no difference in the concentration of nitrite/nitrate in cavernosal homogenate between LETO rats and OLETF rats. By immunohistochemical staining. HIF-1alpha, VEGF, and iNOS were expressed more abundantly in stain in OLETF rats. By RT-PCR analysis, HIF-1alpha mRNA, VEGF mRNA and iNOS mRNA expression levels were higher in the OLETF rats compared to LETO rats. CONCLUSIONS: We suggest that increased HIF-1alpha, VEGF and iNOS expressions in OLETF rat may be associated with microvascular injury in corpus cavernosum. Such microvascular injury is proposed to be associated with vasculogenic erectile dysfunction.

Age-related Changes of Nitric Oxide Synthase Isoforms and Endothelin-1 in Rat Corpus Cavernosum / 대한비뇨기과학회지

PURPOSE: Relaxation of the penile cavernous smooth muscle, which is the main process in penile erection, is controlled by endothelial-derived substances. This study was designed to determine whether aging resulted in altered endothelial autocrine/paracrine function. MATERIALS AND METHODS: We analyzed the distribution of endothelin-1 (ET-1) and nitric oxide synthase (NOS) in the isolated corpus cavernosum from both young (12 weeks old) and aged (50 and 80 weeks old) rats by immunohistochemical (IHC) staining. Vascular mRNA expressions of NOS isoforms and ET-1 were also analyzed by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: The concentration of nitrite/nitrate in the corpus cavernosum was significantly decreased in aged rats but plasma nitrite/nitrate concentration was not changed by aging. IHC staining revealed that the aged vessels showed a marked IHC staining for inducible NOS (iNOS) although the vessels from 12-week-old rats were negative for iNOS. In contrast, there was a reduction of immunoreactivity for endothelial NOS (eNOS) with aging. With aging, expression of eNOS mRNA was slightly decreased in the corpus cavernosum. However, expression of iNOS mRNA was markedly increased with increasing age. IHC staining for vascular ET-1 peptide in young rats showed a scanty distribution in the endothelial cell layer. However, the staining for ET-1 increased both the endothelial cells and vascular smooth muscle layers in the aged rats. mRNA expression of ET-1 gene was upregulated in the aged rats. CONCLUSIONS: It is suggested that the activation of vascular endothelin cascade and alterations in the expression of NOS isoforms may play an important role in the age-dependent, vasculogenic, erectile dysfunction.

Pain Relief by Lidocaine Solution Applied Prior to Intracavernosal Injection Therapy / 대한남성과학회지

PURPOSE: Though intracevernosal injection(ICI) has been widely used to treat erectile dysfunction, its use has been restricted by injection-induced pain. We evaluated pain relief and sexual satisfaction following application of lidocaine solution prior to ICI. MATERIALS AND METHODS: Prospectively, 10 erectile dysfunction patients were given standard ICI treatment 5 times for 4 weeks and then ICI preceded by lidocaine 5 times for 4 weeks. Patients were asked to evaluate ICI-induced pain by the International Pain Scale System, erectile function by the International Index of Erectile Function-5(IIEF-5), sexual satisfaction by Global Assessment Questions(GAQ), and intravaginal ejaculatory latency time. We used Trimix (Standro(R)) and 9.6% lidocaine solution(E.L.T solution(R)) designed to treat premature ejaculation. RESULTS: ICI-induced pain, rated by the International Pain Scale, was significantly reduced from 2.56+/-0.50 to 1.64+/-0.69 by the use of lidocaine before ICI(p0.05). CONCLUSIONS: Application of lidocaine solution prior to ICI decreased ICI-induced pain and increased ejaculatory latency. Therefore, application of lidocaine solution can be a possible assistant method for ICI treatment.

Measurement of Penile Sensitivity by Digital Vibrometer, MMD-1000A(R) / 대한남성과학회지

PURPOSE: The measurement of penile sensitivity is a noninvasive and economical screening method to detect various neurologic disorders including premature ejaculation. We measured the normal range of penile sensitivity using a conventional analogue vibrometer and a new type of digital vibrometer and compared the clinical utility of the two instruments. MATERIALS AND METHODS: The vibration threshold of 50 males who had normal erectile function and ejaculation was measured 3 times with both an analogue and a digital vibrometer. The sites of measurement included the plantar side of the 2nd finger, a distal site on the calf, the penile shaft, and glans. The confidence interval was analyzed by the Kernel density estimation method. RESULTS: The ranges measured by the digital vibrometer were narrower than those measured by the analogue instrument. The normal ranges in the 90% confidence interval by the digital vibrometer were 1.03~.16, 2.49~10.13, 1.54~3.41, 1.61~3.53, 1.91~3.80, 1.55~4.03 Hz/mv in finger tip, calf, right penile shaft, left penile shaft, right glans penis, and left glans penis, respectively. The normal ranges in the 95% confidence interval by digital vibrometer were 1.07~2.15, 3.23~9.50, 1.58~3.33, 1.65~3.48, 1.93~3.38, 1.83~3.73 Hz/mv in finger tip, calf, right penile shaft, left penile shaft, right glans penis, and left glans penis, respectively. The results from the digital vibrometer were more consistent than those by the analogue vibrometer. CONCLUSIONS: The digital vibrometer, MMD-1000A(R) can substitute for the analogue type and has the advantages of greater convenience and more precise measurement of penile sensitivity.

Changes of Subtypes of Anterior Vaginal Wall Collagen in Female with Stress Urinary Incontinence

PURPOSE: Objective of this study is to determine changes in the levels of type I and III collagen in women with stress urinary incontinence (SUI). MATERIALS AND METHODS: Forty-nine women were enrolled to this study and e divided into two groups. Forty-four patients with SUI and 5 patients with without SUI for control. All the women were underwent a pre-operative evaluation. The presence of collagen type I and III was determined by immunohistochemical technique. Analysis of staining was studied with help of specialist of pathology with Image Pro computerized program. The student t-test was used for statistical analysis. RESULTS: Collagen type I and III was significantly reduced (p<0.05) in patients with SUI in anterior vaginal wall tissue. compared to patients in control. Both collagen type I and III were marked reduced in the patient of severe grade of stress urinary incontinence. However there were no significant relation between quantity of collagen and other etiological factors including age, parity, grade, and menopausal. CONCLUSION: In this study, women with SUI have less collagen type I and III around the urethra regardless of the degree of pelvic relaxation, SUI grade, parity, menopausal, age. It appears that collagen has a significant role in the maintenance of urinary continence.