Factors Affecting Unmet Healthcare Needs among Adults with Chronic Diseases

Purpose@#In adults with chronic diseases, unmet healthcare needs are likely to increase the risk of worsening the illness and complications. This study was conducted to explore factors affecting unmet healthcare needs among adults with chronic diseases. @*Methods@#A cross sectional study was performed using the data from the seventh Korea National Health and Nutrition Examination Survey (KNHANES Ⅶ), 2016-2017. The sample of this study consisted of 6,104 adults with chronic diseases. The data were analyzed by Rao-Scott x2 test and logistic regression using complex samples analysis. @*Results@#The proportion of subjects who experienced unmet healthcare needs was 10.9% of adults with chronic diseases. The factors affecting unmet healthcare needs of adults with chronic diseases were age, gender, employment status, household income, subjective health status, activity limitation, and perceived stress. @*Conclusion@#The findings of this study suggest that various factors may be associated with their unmet healthcare needs. Finally, the development of strategies to reduce unmet healthcare needs for people with chronic diseases should consider the associated factors presented in the study.

Periodontal regenerative therapy in endo-periodontal lesions: a retrospective study over 5 years

PURPOSE: The aim of this study was to evaluate clinical and radiographic changes and the survival rate after periodontal surgery using deproteinized bovine bone mineral (DBBM) with 10% collagen or DBBM with a collagen membrane in endo-periodontal lesions. METHODS: A total of 52 cases (41 patients) with at least 5 years of follow-up were included in this study. After scaling and root planing with or without endodontic treatment, periodontal regenerative procedures with DBBM with 10% collagen alone or DBBM with a collagen membrane were performed, yielding the DBBM + 10% collagen and DBBM + collagen membrane groups, respectively. Changes in clinical parameters including the plaque index, bleeding on probing, probing pocket depth, gingival recession, relative clinical attachment level, mobility, and radiographic bone gains were evaluated immediately before periodontal surgical procedures and at a 12-month follow-up. RESULTS: At the 12-month follow-up after regenerative procedures, improvements in clinical parameters and radiographic bone gains were observed in both treatment groups. The DBBM + 10% collagen group showed greater probing pocket depth reduction (4.52±1.06 mm) than the DBBM + collagen membrane group (4.04±0.82 mm). However, there were no significant differences between the groups. Additionally, the radiographic bone gain in the DBBM + 10% collagen group (5.15±1.54 mm) was comparable to that of the DBBM + collagen membrane group (5.35±1.84 mm). The 5-year survival rate of the teeth with endo-periodontal lesions after periodontal regenerative procedures was 92.31%. CONCLUSIONS: This study showed that regenerative procedures using DBBM with 10% collagen alone improved the clinical attachment level and radiographic bone level in endo-periodontal lesions. Successful maintenance of the results after regenerative procedures in endo-periodontal lesions can be obtained by repeated oral hygiene education within strict supportive periodontal treatment.

Effect of Head Nurses' Authentic Leadership on Nurses' Job Satisfaction and Nursing Performance: Focusing on the Mediating Effects of Empowerment / 간호행정학회지

PURPOSE: The purpose of this study was to explore the effects of head nurses' authentic leadership and empowerment on job satisfaction, and nursing performance of nurses and to identify the mediating effect of empowerment in the relationships of head nurses' authentic leadership, with nurses' job satisfaction, and nursing performance. METHODS: The sample for this study was 149 nurses from 2 general hospitals located in Busan. Data were collected using self-administered questionnaires and the SPSS/WIN 23.0 program was used for analysis. Mediation analysis was performed according to the Baron and Kenny method and Sobel test. RESULTS: Head nurses' authentic leadership showed positive correlations with empowerment, job satisfaction, and nursing performance. Empowerment showed partial mediating effects in the relationship between head nurses' authentic leadership and nurses job satisfaction, and a perfect mediating effect in the relationship between head nurses' authentic leadership and the performance of nursing. CONCLUSION: The results indicate that it is necessary to develop strategies and applications to enhance nurses' empowerment for improved job satisfaction and nursing performance.

The Association of Health Behaviors with Stress Perception among High School Students in Korea: Based on 2015 Korean Youth Risk Behavior Survey

PURPOSE: The aim of this study is to identify Korean high school students' health behaviors and perceived stress and to examine effects of their health behaviors on their stress perception. METHODS: The subjects were 33,744 high school students who participated in the 11th Korea youth risk behavior web-based survey 2015 in Korea. Data were analyzed using complex samples analysis with the PASW 18.0 program. The questionnaire utilized in this study is designed to find the subjects' general characteristics, health behaviors, and perceived stress. RESULTS: The prevalence of subjects with high level stress was 38.9%(n=13,137) in this study. There were significant differences in the general characteristics and stress perception among the Korean high school students in terms of gender, grade, school achievement, family's affluence, mother's education, perceived happiness, perceived health status, and stressor. The variables of health behaviors of Korean high school students were significantly different from stress perception. Under complex samples logistic regression, predictive factors of stress for the high school students include gender, grade, father's education, family's affluence, living arrangement, perceived health status, perceived happiness, current smoking, current alcohol experience, and enough sleep. CONCLUSION: The study suggests multilateral efforts are needed to help high school students' stress management including health behaviors for high school students.

Effective professional intraoral tooth brushing instruction using the modified plaque score: a randomized clinical trial

PURPOSE: The purpose of this study was to evaluate the efficacy of the modified plaque score (MPS) for assessing the oral hygiene status of periodontitis patients. METHODS: A total of 116 patients were included in this study. After evaluation of the Löe and Silness gingival index (GI), Silness and Löe plaque index (PlI), O'Leary plaque control record (PCR), and MPS, patients were randomly assigned to either a conventional tooth brushing instruction (C-TBI) group (n=56) or a professional intraoral tooth brushing instruction (P-TBI) group (n=60). The MPS and clinical parameters were re-evaluated after scaling and a series of root planing. The convergent validity of MPS with the PlI and PCR was assessed. The measurement time for MPS and PCR was compared according to the proficiency of the examiner. RESULTS: After root planing, the GI, PlI, PCR, and MPS improved from their respective baseline values in both groups. Three different plaque indices including the MPS, showed significant differences between the C-TBI group and the P-TBI group after root planing. The MPS showed significant concurrence with the PCR and PlI. The mean time for PCR measurement was 2.76±0.71 times longer than that for MPS measurement after 2 weeks of training. CONCLUSIONS: MPS seems to be a practical plaque scoring system compared with the PlI and PCR. These findings suggest that repetitive plaque control combined with an easily applicable plaque index (MPS) may facilitate more effective oral hygiene education and improved periodontal health.

Impact of Response to Violence and Resilience to Burnout in Emergency Department Nurses / 임상간호연구

PURPOSE: The purpose of this study was to identify the relationship between response to violence, resilience and burnout and to investigate the factors that affect burnout in emergency room nurses. METHODS: Data from 237 nurses in 15 emergency rooms were collected using a structured questionnaire. Data were analyzed using SPSS 23.0, and the analyses included descriptive statistics, t-test, Mann-Whitney test, ANOVA, Kruskall Wallis test, Pearson correlation, and hierarchical multiple regression. RESULTS: Burnout was positively correlated with response to violence and negatively correlated with resilience in emergency room nurses. Response to violence (β=.466, p<.001), resilience (β=−.308, p<.001), and religion (β=−.131, p=.011) were significant predictors of burnout, and they explained 39.9% of emergency room nurses' burnout. CONCLUSION: Response to violence and resilience were identified as significant factors affecting burnout in emergency room nurses. Therefore, it is necessary to develop strategies to cope effectively with violence and to develop programs that can strengthen resilience.

Clinical Nurses' Job Stress, Emotional labor, Nursing Performance, and Burnout in Comprehensive Nursing Care Service Wards and General Wards / 간호행정학회지

PURPOSE: This study was done to identify and compare nursing performance including job stress, emotional labor and burnout between nurses who work in comprehensive nursing care service wards and general wards. METHODS: Participants were 187 nurses working in a general hospital in Busan which provides comprehensive nursing care service (comprehensive nursing care service ward: 95, general ward: 92). Data were collected using questionnaires and analyzed using descriptive statistics, χ² test, t-test, ANOVA, and multiple regression with the SPSS/WIN 23.0 program. RESULTS: There was no significant difference in the variables between comprehensive nursing care service ward nurses and general ward nurses. Factors influencing burnout were emotional labor in comprehensive nursing care service ward nurses while job stress and emotional labor were the factors influencing burnout in general ward nurses. CONCLUSION: The findings of this study indicate that comprehensive nursing care service can be a positive delivery system for nurses. Therefore, there is a need for strategies to integrate comprehensive nursing care service systematically.

Nurses' Knowledge and Performance of Pain Management at a General hospital / 기본간호학회지

PURPOSE: This study was done to describe level of knowledge and performance of pain management by nurses in general hospitals. METHODS: The study was conducted from August 1 to 28, 2014 with 141 nurses from a general hospital in B city. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, and Pearson correlation coefficient with SPSS 20.0. RESULTS: Average correct response rate for knowledge was 62.7%, indicating poor knowledge of pain management. Mean score for knowledge of pain management was 31.33+/-3.24 out of 50(general knowledge about pain 14.02+/-2.18 out of 20, knowledge on use of analgesics 9.21+/-1.97 out of 20, knowledge on analgesic classification 8.16+/-1.00 out of 10). Mean score for performance of pain management was 3.19+/-.44 out of 4. There was significant difference in knowledge of pain management by age. Performance of pain management differed significantly according to age and type of working unit. No significant relationship was found between knowledge and performance of pain management. CONCLUSION: These findings show that nurses who have good knowledge do not always have good performance of pain management. Therefore, it is necessary to develop new strategies to promote performance as well as continued pain management education to increase ability of nurses to manage pain.

Primary implant stability in a bone model simulating clinical situations for the posterior maxilla: an in vitro study

PURPOSE: The aim of this study was to determine the influence of anatomical conditions on primary stability in the models simulating posterior maxilla. METHODS: Polyurethane blocks were designed to simulate monocortical (M) and bicortical (B) conditions. Each condition had four subgroups measuring 3 mm (M3, B3), 5 mm (M5, B5), 8 mm (M8, B8), and 12 mm (M12, B12) in residual bone height (RBH). After implant placement, the implant stability quotient (ISQ), Periotest value (PTV), insertion torque (IT), and reverse torque (RT) were measured. Two-factor ANOVA (two cortical conditions×four RBHs) and additional analyses for simple main effects were performed. RESULTS: A significant interaction between cortical condition and RBH was demonstrated for all methods measuring stability with two-factor ANOVA. In the analyses for simple main effects, ISQ and PTV were statistically higher in the bicortical groups than the corresponding monocortical groups, respectively. In the monocortical group, ISQ and PTV showed a statistically significant rise with increasing RBH. Measurements of IT and RT showed a similar tendency, measuring highest in the M3 group, followed by the M8, the M5, and the M12 groups. In the bicortical group, all variables showed a similar tendency, with different degrees of rise and decline. The B8 group showed the highest values, followed by the B12, the B5, and the B3 groups. The highest coefficient was demonstrated between ISQ and PTV. CONCLUSIONS: Primary stability was enhanced by the presence of bicortex and increased RBH, which may be better demonstrated by ISQ and PTV than by IT and RT.

A comparative study of combined periodontal and orthodontic treatment with fixed appliances and clear aligners in patients with periodontitis

PURPOSE: With the increasing prevalence of orthodontic treatment in adults, clear aligner treatments are becoming more popular. The aim of this study was to evaluate the effect of orthodontic treatment on periodontal tissue and to compare orthodontic treatment with fixed appliances (FA) to clear aligner treatment (CAT) in periodontitis patients. METHODS: A total of 35 patients who underwent orthodontic treatment in the Department of Periodontology were included in this study. After periodontal treatment with meticulous oral hygiene education, patients underwent treatment with FA or CAT, and this study analyzed patient outcomes depending on the treatment strategy. Clinical parameters were assessed at baseline and after orthodontic treatment, and the duration of treatment was compared between these two groups. RESULTS: The overall plaque index, the gingival index, and probing depth improved after orthodontic treatment (P<0.01). The overall bone level also improved (P=0.045). However, the bone level changes in the FA and CAT groups were not significantly different. Significant differences were found between the FA and CAT groups in probing depth, change in probing depth, and duration of treatment (P<0.05). However, no significant differences were found between the FA and CAT groups regarding the plaque index, changes in the plaque index, the gingival index, changes in the gingival index, or changes in the alveolar bone level. The percentage of females in the CAT group (88%) was significantly greater than in the FA group (37%) (P<0.01). CONCLUSIONS: After orthodontic treatment, clinical parameters were improved in the FA and CAT groups with meticulous oral hygiene education and plaque control. Regarding plaque index and gingival index, no significant differences were found between these two groups. We suggest that combined periodontal and orthodontic treatment can improve patients' periodontal health irrespective of orthodontic techniques.

Perception of Good Death and Attitudes toward Death between ER Nurses and Coroners / 한국호스피스완화의료학회지

PURPOSE: This study was conducted to describe and compare how emergency room (ER) nurses and coroners perceive good death and their attitudes toward death. METHODS: A survey was performed with 51 ER nurses in P city and 44 coroners nationwide. Data were collected from October 1, 2010 through February 28, 2011. Data were analyzed with descriptive statistics, t-test, ANCOVA, Scheffe's test using the IBM SPSS statistics 21.0 program. RESULTS: For the perception of good death and attitudes toward death, coroners scored higher (3.01+/-0.43 and 2.87+/-0.35, respectively) than ER nurses group (2.95+/-0.40 and 2.61+/-0.33, respectively), but the differences were not significant. The results of perception of good death and attitudes toward death were not statistically significant between ER nurses and coroners. CONCLUSION: The study showed no difference between ER nurses' perception of good death and attitudes toward death and those held by coroners. The findings of the study show that it is necessary to offer steady education on death to nurses and coroners to help them build a proper understanding of good death and grow positive attitudes toward death.

Mitochondrial Homeostasis Molecules: Regulation by a Trio of Recessive Parkinson's Disease Genes

Mitochondria are small organelles that produce the majority of cellular energy as ATP. Mitochondrial dysfunction has been implicated in the pathogenesis of Parkinson's disease (PD), and rare familial forms of PD provide valuable insight into the pathogenic mechanism underlying mitochondrial impairment, even though the majority of PD cases are sporadic. The regulation of mitochondria is crucial for the maintenance of energy-demanding neuronal functions in the brain. Mitochondrial biogenesis and mitophagic degradation are the major regulatory pathways that preserve optimal mitochondrial content, structure and function. In this mini-review, we provide an overview of the mitochondrial quality control mechanisms, emphasizing regulatory molecules in mitophagy and biogenesis that specifically interact with the protein products of three major recessive familial PD genes, PINK1, Parkin and DJ-1.

Effect of Spiritual Well-being on Mental Health in Nursing Students / 정신간호학회지

PURPOSE: The aim of this study was to identify the correlation between spiritual well-being and mental health and to examine the effect of spiritual well-being on mental health in nursing students. METHODS: Between October 2011 and November 2012 nursing students (n=193) in 2 universities in 2 cities completed measures of spiritual well-being and mental health. Data were collected using questionnaires and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and multiple regression with the SPSS/Win 20.0 program. RESULTS: All variables correlated significantly with each other in the positive direction: mental health was correlated with existential well-being (r=.72) and religious spiritual well-being (r=.23). The factor influencing mental health was existential well-being (beta=.70, p<.001). Existential well-being explained 51.0% of nursing students' mental health. CONCLUSION: The results of the study indicate that spiritual well-being of nursing students is related to mental health. Especially, existential well-being has a major effect on mental health in nursing students. Therefore, it is necessary to develop strategies which strengthen existential well-being in order to improve perspective nursing students.

Influential Factors Related to Job Satisfaction in Hospice Nurses: Focus on Emotional Labor and Burnout / 간호행정학회지

PURPOSE: The purpose of this study was to identify factors influencing job satisfaction in hospice nurses. The focus was on emotional labor and burnout. METHODS: Between September 30 and October 18, 2013, hospice nurses (n=63) in 5 hospitals in 4 cities completed measures of emotional labor, burnout, and job satisfaction. Data were collected using questionnaires and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and multiple regression with the SPSS/Win 21.0 program. RESULTS: The mean score per item for emotional labor was 3.0, the mean of burnout score was 2.7, and the mean job satisfaction score was 3.4. Emotional labor showed a positive correlation with burnout (r=.61), and a negative correlation with job satisfaction (r=-.52). Burnout showed a negative correlation with job satisfaction (r=-.64). The factors influencing job satisfaction were burnout (beta=-.65, p<.001) and clinical experience (beta=.25, p=.007). Burnout and clinical experience explained 57.0% of the variance in hospice nurses' job satisfaction. CONCLUSION: The findings of this study indicate a need to develop strategies to prevent burnout and control emotional labor in order to increase job satisfaction for hospice nurses.

Rosai-Dorfman Disease Combined with Aortic Vasculitis, Arrhythmia, and Valvular Heart Disease

Rosai-Dorfman disease (RDD) is a rare and benign self-limited disorder with pathologic feature of the lymph node sinuses expanded by a proliferation of distinctive histiocytes. The most often involving site is bilateral cervical lymphadenopathy, followed by the skin and soft tissue. Treatment options, including steroid, chemotherapy, radiotherapy and debulking surgery depend on the symptoms or the extent and localization of the lesions. We encountered a very rare case of RDD at the skin lesions, particularly combined with aortic vasculitis, arrhythmia, and valvular heart disease.

Factors Influencing Clinical Competence in Nursing Students / 기본간호학회지

PURPOSE: The purpose of this study was to investigate factors influencing clinical competence in nursing students. METHOD: The participants were 125 nursing students and data were collected from October 8 to December 18, 2010 using questionnaires with. Collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. RESULTS: There were significant correlations for creativity, problem-solving ability, self-directed learning ability, and clinical competence. The factor influencing clinical competence the most was creativity, followed by problem-solving ability, self-directed learning ability, and grade point average score. The regression model explained 37% of variance in clinical competence. CONCLUSION: The results indicate that for improvement in the clinical competence of nursing students, it is necessary to develop strategies and education programs to enhance creativity, problem-solving ability, and self-directed learning ability.

Hereditary Spastic Paraplegia with a Novel SPAST Mutation Misdiagnosed with Subacute Combined Degeneration

Autosomal dominant hereditary spastic paraplegia (AD-HSP) is due to mutations in the "spastin" gene (SPAST gene) encoding the AAA protein. The main clinical features of "pure" HSP are progressive lower-limb spasticity with corticospinal tracts and dorsal column degeneration without peripheral neuropathy. Here we report the case of HSP with novel SPAST gene mutation that misdiagnosed with subacute combined degeneration initially. A 58-year-old man with gait disturbance came to our hospital. He was unable to regulate his steps by himself. The impaired gait began 3 years after he had undergone subtotal gastrectomy and chemotherapy for 6 months. Thereafter, he started feeling tingling sensations in the hands and feet and acquired gait difficulties. He denied having a family history of abnormal gait or developmental problem. We diagnosed him with subacute combined degeneration on the evidence of history of gastrectomy, lower normal limit of vitamin B12 (363 pg/ml), apparent absence of vibration sensations and paresthesia in the feet. He was intramuscularly administered cyanocobalamin regularly. However, there was no improvement in his condition. We reconsidered his symptoms and signs, decided to examine the SPAST gene, which is the most common mutation in HSP. The SPAST gene, c.870+1delG, heterozygote, splicing mutation is detected from the gene sample. There was no previous information of this polymorphism or mutation at this locus. We examined his two children, and the same mutation was founded in his son. We report a patient of novel SPAST gene mutation with AD-HSP which is misdiagnosed with SCD.

Osteonecrosis of Maxilla in Wegener's Granulomatosis: Case Report

Neuronal autophagy and neurodegenerative diseases

Autophagy is a dynamic cellular pathway involved in the turnover of proteins, protein complexes, and organelles through lysosomal degradation. The integrity of postmitotic neurons is heavily dependent on high basal autophagy compared to non-neuronal cells as misfolded proteins and damaged organelles cannot be diluted through cell division. Moreover, neurons contain the specialized structures for intercellular communication, such as axons, dendrites and synapses, which require the reciprocal transport of proteins, organelles and autophagosomes over significant distances from the soma. Defects in autophagy affect the intercellular communication and subsequently, contributing to neurodegeneration. The presence of abnormal autophagic activity is frequently observed in selective neuronal populations afflicted in common neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, Huntington's disease and amyotrophic lateral sclerosis. These observations have provoked controversy regarding whether the increase in autophagosomes observed in the degenerating neurons play a protective role or instead contribute to pathogenic neuronal cell death. It is still unknown what factors may determine whether active autophagy is beneficial or pathogenic during neurodegeneration. In this review, we consider both the normal and pathophysiological roles of neuronal autophagy and its potential therapeutic implications for common neurodegenerative diseases.

Effect of anti-rheumatic agents on periodontal parameters and biomarkers of inflammation: a systematic review and meta-analysis

PURPOSE: Anti-rheumatic agents target common molecular pathways of inflammation in rheumatoid arthritis (RA) and periodontitis. The purpose of this study was to determine the relative effect of anti-rheumatic agents on the levels of inflammatory biomarkers and periodontal inflammation in RA patients with periodontitis. METHODS: A systematic review and meta-analysis were conducted of studies comparing periodontal parameters of inflammation, such as bleeding on probing, and biomarkers of inflammation in RA patients with periodontitis and healthy adults with and without periodontitis. The search included the electronic databases MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar, inclusive through October 2011, with no language restrictions. Hand searches were conducted of the bibliographies of related journals and systematic reviews. Observational and interventional studies assessing the effects of antirheumatic therapy qualified for inclusion. Two reviewers performed independent data extraction and risk-of-bias assessment. Of the 187 identified publications, 13 studies fulfilled the inclusion criteria. RESULTS: When compared to healthy adults without periodontitis, RA subjects were found to have significantly higher levels of bleeding on probing and limited evidence of higher levels of interleukin-1beta and tumor necrosis factor-alpha (TNF-alpha) in gingival crevicular fluid and saliva. No consistent differences were found in periodontal parameters and inflammatory biomarkers between RA subjects and adults with periodontitis. Studies evaluating the effect of anti-TNF-alpha therapy in RA subjects with periodontitis have yielded inconsistent results. CONCLUSIONS: There are limited data, however, to suggest that anti-TNF-alpha agents can reduce local production of inflammatory cytokines and periodontal inflammation in RA patients with periodontitis.