Association between vitamin D intake and bone mineral density in Koreans aged ≥ 50 years: analysis of the 2009 Korea National Health and Nutrition Examination Survey using a newly established vitamin D database

BACKGROUND/OBJECTIVES: Vitamin D plays an important role in skeletal growth and maintenance and in the prevention of various diseases. We investigated the relationship between vitamin D intake and bone mineral density (BMD) in Korean adults aged ≥ 50 years using the 2009 Korea National Health and Nutrition Examination Survey data. SUBJECTS/METHODS: This study was conducted in 1,808 subjects aged ≥ 50 years with BMD data in Korea. Dietary vitamin D levels were assessed by the 24-hour recall method. BMD was measured using dual-energy X-ray absorptiometry. We investigated general characteristics and the association between these characteristics, vitamin D status, and BMD. RESULTS: Vitamin D intake was significantly lower in the osteoporosis group among women (P 2.51 µg/day (average intake of women) was higher than that of women with a vitamin D intake ≤ 2.51 µg/day (P < 0.001). CONCLUSIONS: Korean adults should increase their BMD by increasing serum 25(OH)D concentration. Furthermore, increasing vitamin D intake could improve BMD, especially in Korean women who consume less calcium than the estimated average requirement.

Vitamin D intake, serum 25OHD, and bone mineral density of Korean adults: Based on the Korea National Health and Nutrition Examination Survey (KNHANES, 2011) / 한국영양학회지

PURPOSE: The purpose of this study was to estimate dietary intake of vitamin D and the relationship between serum 25-hydroxyvitamin D (25OHD) concentration and bone mineral density (BMD) in Korean adults using the 2011 data from the Korea National Health and Nutrition Examination Survey. METHODS: Daily intake of vitamin D and ratio of subjects that consumed less vitamin D than adequate intake (AI) were estimated in 4,879 Korean adults. The relationship between daily intake of vitamin D and serum 25OHD and BMD were analyzed. RESULTS: Average daily intakes of vitamin D were 3.84 ± 0.23 µg/day for men and 2.22 ± 0.11 µg/day for women. Approximately 72~97% of men and 80~99% of women consumed less than the AI of vitamin D for Koreans. Serum 25OHD concentration increased with age, and the ratios of serum vitamin D deficiency (< 20 ng/mL) were 47.8~81.1% for men and 59.4~92.8% for women. Average intake of vitamin D was higher in subjects aged < 50 yr than in those ≥ 50 yr, but lower in serum 25OHD concentration. In subjects aged < 50 yr, serum 25OHD was higher in subjects that consumed 10 µg/day of vitamin D than in those that consumed less than 5 µg/day. In female subjects aged ≥ 50 yr, average intake of vitamin D was associated with higher bone mineral density. CONCLUSION: It was found that dietary intake of vitamin D could increase serum 25OHD concentration in young adults and bone mineral density in old women. Therefore, nutrition policies for enriched foods with vitamin D and nutrition education to consume more vitamin D-rich foods are needed to ameliorate vitamin D status of the Korean population. Adequate intake for Korean population aged < 50 yr might be adjusted upwardly up to 10 µg/day.

Controlling endemic multidrug-resistant Acinetobacter baumannii in Intensive Care Units using antimicrobial stewardship and infection control

BACKGROUND/AIMS: Nosocomial infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have become public-health problem. However, few studies have evaluated the control of endemic MDR A. baumannii in Intensive Care Units (ICUs). Therefore, we investigated the effectiveness of antimicrobial stewardship and comprehensive intensified infection control measures for controlling endemic MDR A. baumannii in ICUs at a tertiary care center. METHODS: Carbapenem use was strictly restricted through antimicrobial stewardship. Environmental cleaning and disinfection was performed at least 3 times per day in addition to basic infection control measures. Isolation using plastic curtains and contact precautions were applied to patients who were colonized or infected with MDR A. baumannii. The outcome was measured as the incidence density rate of hospital-onset MDR A. baumannii among patients in the ICUs. RESULTS: The incidence density rate of hospital-onset MDR A. baumannii decreased from 22.82 cases per 1,000 patient-days to 2.68 cases per 1,000 patient-days after the interventions were implemented (odds ratio, 0.12; 95% confidence interval, 0.03 to 0.4; p < 0.001). The mean monthly use of carbapenems also decreased from 134.99 +/- 82.26 defined daily doses per 1,000 patient-days to 94.85 +/- 50.98 defined daily doses per 1,000 patient-days (p = 0.016). CONCLUSIONS: Concomitant implementation of strict antimicrobial stewardship and comprehensive infection control measures effectively controlled endemic MDR A. baumannii in our ICUs within 1 year.

Mental Distress of Children in Kirogi Families / 정신간호학회지

PURPOSE: The specific aims of the present study were to compare Kirogi children's mental distress and psychosocial factors between short-term (ST) and long-term groups (LT), and to identify predictors of mental distress in the two groups. METHODS: A sample of 107 Kirogi children living in the U.S. participated in this cross-sectional study and completed the following questionnaires: Center for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory for Children, Somatic Symptom Scale, Self-Esteem Scale, Parent-Child (P-C) Relationship Satisfaction Scale, Parent-Adolescent Communication Inventory Social, Attitudinal, Familial, and Environmental Scale, and Social Support Scale. RESULTS: The LT group reported higher scores on depression and anxiety, and lower scores on self-esteem and P-C relationship than the ST group. Higher scores on somatic symptoms were found in the ST group. Problematic mother-child communication and dissatisfaction with father-child relationship were significant predictors for mental distress. Self-esteem predicted depression and anxiety in the ST group; particularly self-esteem was a significant predictor for anxiety in both groups. Discrimination and process-oriented stress were significant predictors for depression and anxiety in the ST group. CONCLUSION: Results of the present study reveal the needs for school-based mental health programs for the increasing number of Kirogi children vulnerable to mental distress.

Successful Control of Extended-spectrum Beta-lactamase-producing Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit / 병원감염관리

BACKGROUND: Extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae is an important cause of nosocomial infections in neonatal intensive care units (NICUs). This study aimed to reduce ESBL-producing K. pneumoniae in the NICU by using infection control measures. METHODS: We performed prospective surveillance cultures, monitoring, and education for infection control in the NICU between May and August 2011. Specimens were collected from all infants and the environment including stethoscopes, thermometers, ventilators, incubators, etc. The anterior nares and hands of healthcare workers were also screened. We inspected infection control practices and provided feedback. The level of infection control awareness was measured using a questionnaire. RESULTS: The level of awareness and performance of hand washing increased significantly after intervention (both P<0.001). The environmental management of healthcare providers also improved significantly (P=0.001). The yield of ESBL-producing K. pneumoniae from clinical specimens decreased gradually throughout the study period (30.4% in May to 12.6% in August). Central catheter-related K. pneumoniae bacteremia decreased from 1.3/1000 to 0/1000 catheter-days. CONCLUSION: Infection control measures including education, monitoring, and surveillance can lower the incidence of ESBL-producing K. pneumoniae in the NICU.

Clinical Outcomes and Quality of Life of Home Health Care Patients

PURPOSE: This study aimed to evaluate the quality of life (QOL) in home health care patients according to change in health status outcomes between the start of care and discharge or 60 days, whichever came first. METHODS: This is a prospective descriptive study. The convenience sample consisted of 100 home health care patients, who started receiving home health care services from a home health care agency in the United States. The World Health Organization Quality of Life Scale-Brief (WHOQOL-BREF) was used for measuring QOL; activities of daily living (ADLs) and instrumental ADLs were collected from the Outcome and Assessment Information Set data via Centers for Medicare and Medicaid Services-required home health agencies. Descriptive statistics, paired t tests, and multiple linear regressions were used for data analysis. RESULTS: ADLs and instrumental ADLs of participants significantly improved between start of care and discharge or 60 days. Overall QOL, general health, and three of four QOL domains (physical, psychological, and environmental, but not social domain) were significantly improved at discharge or 60 days. CONCLUSION: Home health care nurses should maintain and improve the functional ability of patients, as this could improve the QOL of these patients.

Individual and Environmental Factors Influencing Questionable Development among Low-income Children: Differential Impact during Infancy versus Early Childhood

PURPOSE: From the holistic environmental perspective, individual and environmental influences on low-income children's questionable development were identified and examined as to differences in the influences according to the child's developmental stage of infancy (age 0-35 months) or early childhood (age 36-71 months). METHODS: This study was a cross-sectional comparative design using negative binominal regression analysis to identify predictors of questionable development separately for each developmental stage. The sample was comprised of 952 children (357 in infancy and 495 in early childhood) from low-income families in South Korea. Predictors included individual factors: child's age and gender; proximal environmental influences: family factors (family health conditions, primary caregiver, child-caregiver relationship, depression in primary caregiver) and institution factors (daycare enrollment, days per week in daycare); and distal environmental influences: income/resources factors (family income, personal resources and social resources); and community factors (perceived child-rearing environment). The outcome variable was questionable development. RESULTS: Significant contributors to questionable development in the infancy group were age, family health conditions, and personal resources; in the early childhood group, significant contributors were gender, family health conditions, grandparent as a primary caregiver, child-caregiver relationships, daycare enrollment, and personal resources. CONCLUSION: Factors influencing children's questionable development may vary by developmental stage. It is important to consider differences in individual and environmental influences when developing targeted interventions to ensure that children attain their optimal developmental goals at each developmental stage. Understanding this may lead nursing professionals to design more effective preventive interventions for low-income children.

Factors Associated with Blue-collar Workers' Risk Perception of Cardiovascular Disease

PURPOSE: The purpose of this study was to investigate the contribution of actual cardiovascular disease (CVD) risk, as well as, individual, psychosocial, and work-related factors as predictors of CVD risk perception among Korean blue-collar workers. METHODS: The participants were 238 Korean blue-collar workers who worked in small companies. Data were collected through a survey; anthropometric and blood pressure measures; and blood sampling for lipid levels. RESULTS: Blue-collar workers had high actual CVD risk and low CVD risk perception. The significant predictors of risk perception included perceived health status, alcohol consumption, knowledge of CVD risk, actual CVD risk, decision latitude, and shift work. The model explained 26% of the variance in CVD risk perception. CONCLUSION: The result suggests when occupational health nurses are giving routine health examination in small companies, they can enhance CVD risk perception in blue-collar workers by providing essential information about CVD risk factors and personal counseling on the individual worker's CVD risk status.

Insulinotrophic and hypolipidemic effects of Ecklonia cava in streptozotocin-induced diabetic mice

OBJECTIVE@#To explore the anti-diabetic activity of Ecklonia cava (EC) in streptozotocin (STZ)-induced diabetic mice.@*METHODS@#Diabetes was induced by a single intraperitoneal injection of STZ (90 mg/kg). Normal and diabetic mice were treated with 0%, 3%, and 5% EC diet for 4 weeks. Serum glucose and insulin concentrations, serum lipid profile, oral glucose tolerance test, and liver and pancreatic β-cell histopathological observations were performed. In addition, in vitro glucose-induced insulin secretion was determined using pancreatic β-islet cells.@*RESULTS@#EC supplementation significantly and dose-dependently decreased serum glucose concentration, and improved glucose homeostasis in diabetic mice by preventing loss of β-cell mass resulting in increase of insulin secretion. The triglyceride and total cholesterol concentrations in the serum and liver were markedly reduced by EC treatment in STZ-diabetic mice. Moreover, LDL-, and HDL-cholesterol levels were ameliorated in EC supplemented diabetic mice. Liver steatosis induced by STZ was ameliorated by EC supplementation. Furthermore, in vitro insulinotrophic effect of EC extract was observed in pancreatic β-islets.@*CONCLUSIONS@#This study demonstrated that EC is a potent and efficacious hypoglycemic and hypolipidemic agent, and prevents the loss of β-cell mass resulting in increase of insulin secretary capacity.

Evaluation of Efficiency of Community Visiting Health Service Units: A Demonstration of Using Data Envelopment Analysis (DEA) / 간호행정학회지

PURPOSE: The aim of this study was to evaluate the efficiency of community visiting health service units using DEA and to compare the results with those of traditional evaluation methods. METHODS: Data were collected using 2008 annual reports of 10 districts in one city. Input variables were number of staff and operational budget per year and output variables were number of managed household per nurse, rate of controlled hypertension, and diabetes mellitus. EMS Window version 3.1 was used to measure efficiency score and bootstrapping Chi-square test was applied to identify differences between efficient and non-efficient unit by organizational factors. RESULTS: The average efficiency score of 10 community visiting health services was about 66%. Only two of the units operated program efficiently. The career of the staff was one among other factors associated with efficiency. The evaluation results from the traditional method and DEA were totally different. CONCLUSION: These results indicate that, evaluation methods have very important and significant effects on the evaluation results of community visiting health service units. The DEA method is recommend as an alterative method for evaluating community visiting health service.

Comparison of Benefit Estimation Models in Cost-Benefit Analysis: A Case of Chronic Hypertension Management Programs

PURPOSE: Cost-benefit analysis is one of the most commonly used economic evaluation methods, which helps to inform the economic value of a program to decision makers. However, the selection of a correct benefit estimation method remains critical for accurate cost-benefit analysis. This paper compared benefit estimations among three different benefit estimation models. METHODS: Data from community-based chronic hypertension management programs in a city in South Korea were used. Three different benefit estimation methods were compared. The first was a standard deterministic estimation model; second, a repeated-measures deterministic estimation model; and third, a transitional probability estimation model. RESULTS: The estimated net benefit of the three different methods were $1,273.01, $-3,749.42, and $-5,122.55 respectively. CONCLUSION: The transitional probability estimation model showed the most correct and realistic benefit estimation, as it traced possible paths of changing status between time points and it accounted for both positive and negative benefits.

Analysis of Cost and Efficiency of a Medical Nursing Unit Using Time-Driven Activity-Based Costing

PURPOSE: Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. METHODS: Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. RESULTS: The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. CONCLUSION: These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.

Perceived Cognitive Function and Related Factors in Korean Women With Breast Cancer

PURPOSE: The aim of this study was to explore perceived cognitive function and its related factors in breast cancer patients that had received or were receiving adjuvant chemotherapy after surgery. METHODS: A cross-sectional and correlational design was used in this study. A total of 118 women who had undergone or were undergoing adjuvant chemotherapy after breast cancer surgery recruited from a convenience sample from a university hospital in Korea were included in the study. The attentional function index was used to measure perceived cognitive function while the linear analogue self-assessment scale was used to measure mood disturbance. Hierarchical multiple regression analyses were done to determine possible predictors of perceived cognitive function in patients with breast cancer. RESULTS: Perceived cognitive function and mood disturbance had a mean score of 66.22 (SD = 13.43) and 159.78 (SD = 81.40), respectively. Mood disturbance was a statistically significant predictor of cognitive function in patients with breast cancer. CONCLUSIONS: Breast cancer patients with mood disturbance may experience decrements in perceived cognitive function. Nurses should be aware of mood changes and its influence on perceived cognitive function in breast cancer patients.

Breeding of a Silkworm Variety for Synnemata Production of Isaria tenuipes

This study was conducted out to select a silkworm variety suitable for synnemata production of Isaria tenuipes. Four kinds of the mulberry silkworm varieties, Bombyx mori, were hybridized using a Japanese parental line and a Chinese parental line, and used to test for synemata formation in I. tenuipes. The larval period of normal silkworms was 22 hr longer than the silkworms inoculated with this fungus. Among the silkworm varieties tested, Hachojam had the shortest larval period with 23.02 days. The non-cocooning silkworm had a shorter larval period than the cocoon producing silkworms. The pupation rate of normal silkworms was about 9% higher than that of silkworms sprayed with I. tenuipes. Hachojam had the highest infection rate at 99.8%, but no significant difference was observed for the infection rate by silkworm variety. The production of synnemata was the best in JS171 x CS188 with an incidence rate of 99.3%, followed by Hachojam, and Chugangjam. The synnemata produced from Hachojam were the heaviest and showed white or milky-white in color.

Assessment of antero-posterior skeletal relationships in adult Korean patients in the natural head position and centric relation / 대한치과교정학회지

OBJECTIVE: This study aimed to verify the intra-individual reproducibility of the natural head position (NHP) in adult Korean patients in the centric relation (CR) position and to prove the inter-individual variability of the Frankfurt horizontal (FH) plane and sella-nasion (SN) line compared to the true horizontal line (THL). In addition, the study aimed to investigate the correlations between linear measurements from A-point and B-point to the nasion true vertical line (NTVL) and angular measurements from A-point and B-point to the SN line. METHODS: Two lateral cephalograms were taken of 116 subjects (23 males, 93 females) with CR wax bites in a NHP at a one-week interval. RESULTS: Method errors of three variables and intraclass correlation coefficients of six parameters proved the intra-individual reproducibility of NHP (p 0.05), but it was clinically variable (SD 3.89degrees) on the inter-individual level. Conversely, the angle of the SN line to the THL was significantly different from 7degrees (p < 0.05). Very low correlation was found between the linear measurements and angular measurements of A-point and B-point (p < 0.01). CONCLUSIONS: The NTVL could be a useful reference line for assessing the antero-posterior position of the maxilla and mandibleof Korean adult patients in NHP and CR.

Effects of Low Glycemic Index Nutrition Education on the Blood Glucose Control in Patients with Type 2 Diabetes Mellitus

This study was intended to assess the effects of low glycemic index (LGI) nutrition education on dietary management and glycemic control of patients with type 2 diabetes mellitus. The subjects were 48 sex-matched patients with type 2 diabetes mellitus, aged 66.5 +/- 6.2 years, visiting a public health center. They were divided into two groups: the control group (males 10, females 14) and the educated group (males 10, females 14). The educated group was provided with a LGI nutrition education program for 7 weeks. The control group was educated only one time for general diabetic education. Anthropometric indices, knowledge and perception of efficacy of low glycemic index carbohydrates, dietary glycemic index (DGI) and glycemic load (DGL), fasting blood glucose, and HbA1c were assessed. In the educated group body weight, body mass index and systolic blood pressure (from 138.0 +/- 18.9 mmHg to 130.6 +/- 15.0 mmHg) were significantly reduced after the nutrition education (p < 0.05). The scores of knowledge and perception of efficacy of low glycemic index carbohydrates increased significantly in the educated group. Dietary glycemic index and glycemic load of the educated group decreased significantly from 103.4 +/- 67.6 to 45.4 +/- 27.1 (p < 0.001), and from 173.3 +/- 135.9 to 66.8 +/- 50.4 (p < 0.001), respectively. Also fasting blood glucose and HbA1c levels of the educated group significantly decreased from 124.5 +/- 28.8 mg/dL to 96.7 +/- 21.6 mg/dL (p < 0.001) and from 7.1 +/- 1.3% to 6.4 +/- 1.2% (p < 0.05), respectively. The score of knowledge and perception of efficacy of low glycemic index significantly correlated with fasting blood glucose and HbA1c levels negatively. DGI, DGL and duration of diabetes significantly correlated with HbA1c level positively. From stepwise multiple linear regression analysis, DGI, DGL and the duration of diabetes were extracted as factors influencing HbA1c level of the subjects. The results of this study suggest that low glycemic index nutrition education programs is an effective intervention measure for the glycemic control in type 2 diabetic patients.

beta-Glucan enhanced apoptosis in human colon cancer cells SNU-C4

The apoptotic effect of bacteria-derived beta-glucan was investigated in human colon cancer cells SNU-C4 using terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) assay, reverse transcription-polymerase chain reaction (RT-PCR) expressions of Bcl-2, Bax, and Caspase-3 genes, and assay of caspase-3 enzyme activity. beta-Glucan of 10, 50, and 100 microg/mL decreased cell viability in a dose-dependent manner with typical apoptotic characteristics, such as morphological changes of chromatin condensation and apoptotic body formation from TUNEL assay. In addition, beta-glucan (100 microgram/mL) decreased the expression of Bcl-2 by 0.6 times, whereas the expression of Bax and Caspase-3 were increased by 3.1 and 2.3 times, respectively, compared to untreated control group. Furthermore, the caspase-3 activity in the beta-glucan-treated group was significantly increased compared to those in control group (P < 0.05). Bacterial derived beta-glucan could be used as an effective compound inducing apoptosis in human colon cancer.

Arterial arcade of the maxillary sinus related to sinus bone graft in korean population ; A preliminary study using computed topographies

AIM: The aim of this study was to investigate the arterial arcade of maxillary sinus by determining the distance between the alveolar crest and the inferior border of the vessels in Korean population. MATERIALS AND METHODS: 76 patients and 87 available sinuses were determined by CT scan (Implagraphy, Vatech, Seoul, Korea). The distance between alveolar crest and inferior border of the vessel was determined considering the tooth area of posterior maxilla. RESULTS: The lowest distance was observed on first molar area and the average distance is 16.9 mm. DISCUSSIONS: it is important in sinus lift surgery that the vessels not to be damaged and that the anastomosis is situated in the lateral wall of maxillary sinus, which has to be exposed to gain access to the maxillary sinus. The knowledge of arterial arcade of maxillary sinus is important to perform the sinus floor elevation procedure effectively.

Balanced Scorecard for Performance Measurement of a Nursing Organization in a Korean Hospital / 간호학회지

PURPOSE: The purpose of this study was to develop a balanced scorecard (BSC) for performance measurement of a Korean hospital nursing organization and to evaluate the validity and reliability of performance measurement indicators. METHOD: Two hundred fifty-nine nurses in a Korean hospital participated in a survey questionnaire that included 29-item performance evaluation indicators developed by investigators of this study based on the Kaplan and Norton's BSC (1992). Cronbach's alpha was used to test the reliability of the BSC. Exploratory and confirmatory factor analysis with a structure equation model (SEM) was applied to assess the construct validity of the BSC. RESULT: Cronbach's alpha of 29 items was .948. Factor analysis of the BSC showed 5 principal components (eigen value >1.0) which explained 62.7% of the total variance, and it included a new one, community service. The SEM analysis results showed that 5 components were significant for the hospital BSC tool. CONCLUSION: High degree of reliability and validity of this BSC suggests that it may be used for performance measurements of a Korean hospital nursing organization. Future studies may consider including a balanced number of nurse managers and staff nurses in the study. Further data analysis on the relationships among factors is recommended.

Educational Issues and Strategies to Improve APN Education / 간호학회지

PURPOSE: This study was aimed at exploring the current status of graduate programs for an advanced practice nurse(APN) to recommend future directions of APN education. METHODS: A total of 142 students enrolled in seven APN specialty programs, 67 professors who were involved in APN education, and nine nurse administrators participated in the study. Data was collected by questionnaires and focus group interviews. RESULTS: The current definition of APN was found not to be specific enough to represent expected roles of APN in regards to knowledge, attitudes, roles, and skills. Standard curricula employed regardless of the area of APN specialty, lack of qualified clinical practice settings, as well as prepared instructors were found to be problematic. CONCLUSION: The following needs to be addressed: 1. redefining of APN roles, 2. tailoring specialty areas of APN, 3. consolidating educational programs, and 4. ensuring APN role models and faculty. Suggesting a CNS role in Korean APN, areas of APN should be rearranged toclarify their roles and educational programs need to be further developed to meet the expectations and quality of APNs. It is necessary to ensure APN's employment in the health care system by laws and policies to perform advanced nursing roles.