Factors Influencing Sleep Disturbance of Novice Nurses: Focusing on Sleep Hygiene and Physical Activity - Longitudinal Study of Secondary Data / 간호행정학회지

Purpose@#The aim of this study was to longitudinally compare novice nurses’ sleep disturbance, sleep hygiene, and physical activity and analyze factors affecting sleep disturbance. @*Methods@#Data were obtained from three follow-up surveys of 178 novice nurses. The data were analyzed using SPSS 25.0 to calculate descriptive statistics. A repeated measures ANOVA and Cochran’s Q test were performed, and a logistic regression analysis was conducted using generalized estimation equations. @*Results@#The sleep disturbance rate increased significantly over time in the following order: before the start of shift work, after six months of shift work, and after 18 months of shift work (T=98.67, p<.001). Sleep hygiene significantly deteriorated over time after the start of shift work (F=127.95, p<.001). Arousal behavior (OR=10.34, p<.001) and the sleep environment (OR=1.54, p=.005) in sleep hygiene, significantly influenced sleep disturbance. Stretching exercises were an influencing factor in sleep disturbance (OR=1.71, p=.039). @*Conclusion@#Sleep disturbance among novice nurses increased after the start of shift work. Sleep hygiene and stretching were influencing factors. Therefore, to prevent and reduce sleep disturbance in novice nurses, efforts are needed to improve sleep hygiene and promote stretching exercises.

Olfactory neuroepithelium in the middle turbinate: is there any impact on olfaction function after lateral marsupialization for concha bullosa surgery?

Abstract Introduction: The effect of the quantity of olfactory neuroepithelium in the middle turbinate on the postoperative olfactory function for middle turbinate concha bullosa patients has not yet been evaluated. Objective: The primary aim of this study was to investigate the olfactory structures in the middle turbinate by immunohistochemical analysis of the olfactory marker protein and to correlate the immunostaining results with the olfaction test results for patients with middle turbinate concha bullosa. Methods: Surgical materials of 18 middle turbinate concha bullosa patients who had undergone lateral marsupialization surgery were immunostained with olfactory marker protein antibodies. Smell diskettes olfaction test was applied to all of the study group patients both preoperatively and three months postoperatively. A visual analog scale was used to quantify the sense of nasal obstruction. Results: It was observed that the postoperative smell scores and the nasal obstruction visual analog scale values were significantly improved as compared to the preoperative values (p<0.05). In addition, there was a significant correlation between the smell score gain and the visual analog scale gain values (r = 0.682). Results also indicated no significant correlation between the olfactory marker protein staining scores and the smell scores (p > 0.05). Conclusion: This first paper demonstrated that the quantity of the olfactory mucosa in the middle turbinate was not a determining factor for the postoperative smell function degree for middle turbinate concha bullosa patients. The underlying cause of the olfactory deficit for middle turbinate concha bullosa patients seems to be obstruction related rather than the middle turbinate's olfactory mucosa containing status.

The effectiveness of propranolol, flunarizine, amitriptyline and botulinum toxin in vestibular migraine complaints and prophylaxis: a non-randomized controlled study / A eficácia de propranolol, flunarizina, amitriptilina e toxina botulínica nas queixas e profilaxia da migrânea vestibular: um estudo controlado não randomizado

Abstract Introduction: Vestibular migraine is the most common cause of spontaneous episodic vertigo in adult patients and the second most common cause of vertigo in patients of all ages. Objective: To assess the effectiveness of oral medication type (propranolol, flunarizine, and amitriptyline) and botulinum toxin A application on vestibular symptoms, headache severity and attack frequency for vestibular migraine patients. Methods: Sixty patients with vestibular migraine were enrolled. Thirty patients received botulinum toxin A treatment (B+ group) in addition to the oral medication, whereas 30 patients received only oral medication (B− group). Headache severity was evaluated with Migraine Disability Assessment Scale and vertigo severity was evaluated with Dizziness Handicap Inventory scale. Vestibular migraine attack frequencies in the last three months were also evaluated. Results: There was a statistically significant decrement in mean Dizziness Handicap Inventory scores, Migraine Disability Assessment Scale scores and vertigo attack frequencies after treatment for all patients, B+ and B− group patients (p < 0.001 for all). The mean Migraine Disability Assessment Scale score gains (p < 0.001) and vertigo attack frequency gains (p = 0.003) were significantly higher in the B+ patients than B− patients. Conclusions: Both B+ and B− group patients exhibited significant improvement in vestibular migraine attack frequencies, Dizziness Handicap Inventory score and Migraine Disability Assessment Scale score values. However, botulinum toxin A application had a more pronounced effect for Migraine Disability Assessment Scale score gain and vestibular migraine attack frequency values, but not for Dizziness Handicap Inventory score gain values. Thus, botulinum toxin A application should be considered for vestibular migraine patients whose headache severity degrees are more profound. The oral medication type (propranolol, flunarizine or amitriptyline) did not differ in influencing the vestibular migraine attack frequency, Dizziness Handicap Inventory score gain and Migraine Disability Assessment Scale score gain values.

Resumo Introdução: A migrânea vestibular é a causa mais comum de vertigem episódica espontânea em pacientes adultos e a segunda causa mais comum de vertigem em pacientes de todas as idades. Objetivo: Avaliar a eficácia da aplicação dos tipos de medicamentos orais (propranolol, flunarizina e amitriptilina) e da toxina botulínica tipo A sobre os sintomas vestibulares, intensidade da cefaleia e frequência das crises em pacientes com migrânea vestibular. Método: Sessenta pacientes com migrânea vestibular foram incluídos. Trinta pacientes receberam tratamento com toxina botulínica tipo A e medicação oral (Grupo B+), enquanto 30 pacientes receberam apenas medicação oral (Grupo B-). A intensidade da cefaleia foi avaliada pelo migraine disability assessment scale e a gravidade da vertigem foi avaliada com o dizziness handicap inventory. A frequência das crises de migrânea vestibular nos últimos três meses também foi avaliada. Resultados: Houve um decréscimo estatisticamente significativo na média dos escores do dizziness handicap inventory e migraine disability assesment scale e na frequência das crises de vertigem após o tratamento em todos os pacientes, p < 0,001 para todos os pacientes dos grupos B+ e B−. Os ganhos médios no escore do migraine disability assesment scale (p < 0,001) e na frequência das crises de vertigem (p = 0,003) foram significantemente maiores nos pacientes B+ do que nos pacientes B−. Conclusões: Os pacientes de ambos os grupos B+ e B− exibiram melhoria significativa na frequência das crises de migrânea vestibular e nos valores dos escores do dizziness handicap inventory e do migraine disability assesment scale. No entanto, a aplicação da toxina botulínica tipo A teve um efeito mais pronunciado para os valores de ganho no escore do migraine disability assesment scale e na frequência das crises de migrânea vestibular, mas não para os valores de ganho no escore do dizziness handicap inventory. Portanto, a aplicação de toxina botulínica tipo A deve ser considerada para pacientes com migrânea vestibular, cujos graus de intensidade da cefaleia são mais marcantes. O tipo de medicação oral (propranolol, flunarizina ou amitriptilina) não diferiu em relação à frequência das crises de migrânea vestibular e aos valores de ganho dos escores do dizziness handicap inventory e do migraine disability assesment scale.

Changes in Stress, Occupational Stress, and Subjective Health Problems of Novice Female Nurses: Secondary Data Analysis

Purpose@#This study aimed to examine the changes in stress, occupational stress, and subjective health problems of novice female nurses within the first 18 months of work. @*Methods@#This was a longitudinal study conducted with a secondary data analysis based on the Shift Work Nurse’s Health and Turnover (SWNHT) study. The participants were 178 female novice nurses who participated in all 3 data collection activities (on the first day of orientation before ward placement [T0], 6 months after work [T1], and 18 months after work [T2]). The stress, occupational stress, 8 subjective health problems (upper musculoskeletal pain, leg/foot discomfort, depression, anxiety or emotional disorder, sleep disturbance, headache, gastrointestinal disorder, menstrual disorder, and others), and the greatest health problem during the study period were measured, respectively. Data were analyzed using SPSS 26.0 to obtain descriptive statistics. @*Results@#The subjective health of novice female nurses were found to be poor at T1 compared to T0 on both physical (upper musculoskeletal pain, leg/foot discomfort, and sleep disturbance) and psychological health problems (depression and stress). However, the psychological health problems of the participants were alleviated at T2 whereas; physical health problems persisted until T2. @*Conclusion@#Novice nurses had poor health problems 6 months after work. Sleep disturbance and musculoskeletal pain persisted although other health problems such as depression and stress were alleviated over the period. Strategies to prevent and manage different health problems of novice female nurses at different work duration are urgently needed.

Changes in Dietary Behavior of Shift Work Nurses: A Longitudinal Study / 간호행정학회지

Purpose@#This study aimed to identify the changes in dietary behavior of shift work nurses and its influencing factors over time. @*Methods@#This was a secondary data analysis study based on the Shift Work Nurses’ Health and Turnover study. Data of 165 shift work nurses, who were followed for three-time points [before shift work (T0), after 6 months (T1), and after 18 months(T2) of shift work], were analyzed. Dietary behavior, level of stress, fatigue, depressive symptoms, and the amount of physical activity were measured. SPSS 28.0 was used to analyze the data to acquire descriptive statistics, repeated-measures ANOVA, and multiple linear regression with generalized estimating equations (GEE). @*Results@#Dietary behavior of shift work nurses was poorer at T1 and T2 as compared to T0. As a result of GEE, shift work duration, level of stress, fatigue, and depressive symptoms were found to have negative impacts on dietary behavior. @*Conclusion@#Dietary behavior deteriorated and remained poor over time since shift work began. Shift work, along with stress, fatigue, and depressive symptoms, were the factors influencing their dietary behavior. Thus, to improve shift work nurses’ dietary behavior, efforts to decrease stress, and alleviate fatigue and depressive symptoms are urgently required.

Onboard emergency medical equipment in Korean airlines

Objective@#This study aimed to identify the frequency of use of in-flight medical equipment and the status of medications loaded with common symptoms. @*Methods@#We conducted a survey of airlines to identify onboard medication and medical equipment from July 1 to 31, 2020. @*Results@#A total of seven airlines participated in this study (two full service and five low cost carriers). The most commonly reported frequencies of using first aid kit and emergency medical kit were less than five cases per month (57.1% and 71.4%, respectively). Most airlines were equipped with medications for burn (85.7%), abdominal pain (100%) and fever (100%), which are frequently reported in-flight medical incidents. However, only two airlines were equipped with medications for psychiatric symptoms commonly reported in-flight medical incidents. @*Conclusion@#Most airlines loaded medications for major in-flight symptoms. However, it is necessary to equip the additional medications for the burn and psychiatric symptoms.

Comparison of Occupational Stress and Health Problems between Leavers and Stayers: Focused on Novice Nurses

Purpose@#This study aimed to identify occupational stress and health problems as well as turnover reasons among leavers in novice nurses and to estimate factors which might affect turnover by comparing them to stayers. @*Methods@#In this study, secondary analysis of data gathered from the Shift Work Nurse’s Health and Turnover studies, was carried out. The data were collected from 204 stayers who have been working for 18 months since 2018 and 48 leavers who left within the same period at two tertiary hospitals in Seoul. The reasons for turnover, occupational stress, and 8 types of health problems were recorded. The data were analyzed using SAS 9.4 to obtain descriptive statistics. In parallel, Pearson’s chi-squared test, Fisher’s exact test, and independent t-test were also conducted. @*Results@#The main reasons for turnover were job stress and difficult interpersonal relationships in the workplace. Occupational stress of leavers was higher than stayers, especially in the subscales of interpersonal conflict, organizational system, lack of reward, and occupational climate. Among the 8 types of health problems, the depression prevalence of leavers was higher compared to stayers and showed marginal significance. Unexpectedly, the sleep disturbance prevalence of stayers was significantly higher compared to leavers. @*Conclusion@#To reduce the turnover rate of novice nurses, education on how to cope with occupational stress is needed. A customized program for novice nurses to overcome the difficulties of interpersonal relations would be helpful.

Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger / 대한뇌졸중학회지

Background@#and Purpose Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied. @*Methods@#This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim’s criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP. @*Results@#A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP. @*Conclusions@#The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.

Comparison of Occupational Stress and Health Problems between Leavers and Stayers: Focused on Novice Nurses

Purpose@#This study aimed to identify occupational stress and health problems as well as turnover reasons among leavers in novice nurses and to estimate factors which might affect turnover by comparing them to stayers. @*Methods@#In this study, secondary analysis of data gathered from the Shift Work Nurse’s Health and Turnover studies, was carried out. The data were collected from 204 stayers who have been working for 18 months since 2018 and 48 leavers who left within the same period at two tertiary hospitals in Seoul. The reasons for turnover, occupational stress, and 8 types of health problems were recorded. The data were analyzed using SAS 9.4 to obtain descriptive statistics. In parallel, Pearson’s chi-squared test, Fisher’s exact test, and independent t-test were also conducted. @*Results@#The main reasons for turnover were job stress and difficult interpersonal relationships in the workplace. Occupational stress of leavers was higher than stayers, especially in the subscales of interpersonal conflict, organizational system, lack of reward, and occupational climate. Among the 8 types of health problems, the depression prevalence of leavers was higher compared to stayers and showed marginal significance. Unexpectedly, the sleep disturbance prevalence of stayers was significantly higher compared to leavers. @*Conclusion@#To reduce the turnover rate of novice nurses, education on how to cope with occupational stress is needed. A customized program for novice nurses to overcome the difficulties of interpersonal relations would be helpful.

Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger / 대한뇌졸중학회지

Background@#and Purpose Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied. @*Methods@#This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim’s criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP. @*Results@#A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP. @*Conclusions@#The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.

The Factors Associated with Dietary Knowledge and Educational Needs of Stroke Patients

Purpose@#The purpose of the this study was to examine the dietary knowledge and educational needs of stroke patients and analyze the related factors that are associated with dietary knowledge and educational needs. @*Methods@#Our study analyzed data from 146 stroke patients. The survey was conducted by individual interviews using questionnaires and data collected from participants’ medical records. Dietary knowledge and educational needs were measured by tools developed by the author. @*Results@#The mean scores for the dietary knowledge and educational needs were 19.09± 3.48 and 36.17± 7.18, respectively. Many stroke patients had misconceptions about soy sauce, cholesterol, and fruits. The most needed items in dietary education was first identifying foods that are beneficial or harmful, and second, food interaction with medications. As for the results of multiple regressions, dietary knowledge was significantly associated with gender, educational attainment, monthly income, exercise, body mass index, and level of compliance to dietary therapy. Additionally, the educational needs were significantly related with educational attainment and employment. @*Conclusion@#For secondary prevention of stroke patients, education strategy considering dietary knowledge and educational needs of stroke patients should be established. Special attention is needed for stroke patients with a lower level of dietary knowledge and educational needs.

Secondary Data Analysis on the Factors Influencing Premenstrual Symptoms of Shift Work Nurses:Focused on the Sleep and Occupational Stress

Purpose@#This study aimed to examine premenstrual symptoms (PMS) of shift nurses and identify the association between PMS, sleep, and occupational stress. @*Methods@#This study was conducted with a secondary data analysis that used data from the Shift Work Nurse’s Health and Turnover study. The participants were 258 nurses who were working in shifts including night shifts. PMS, sleep patterns (sleep time and sleep time variability), sleep quality, and the occupational stress of each participant were measured using the Moos Menstrual Distress Questionnaire, a sleep diary, an actigraph, the Insomnia Severity Index, and the Korean Occupational Stress Scale, respectively. Data were analyzed using SPSS 23 and STATA 15.1 to obtain descriptive statistics, Pearson’s correlation coefficients, multiple linear regression with generalized estimating equations (GEE) and Baron and Kenny’s mediating analysis. @*Results@#The average PMS score, average sleep time, average sleep time variability, average sleep quality score, and average occupational stress score of the participants was 53.95 ± 40.45, 7.52 ± 0.89 hours, 32.84 ± 8.43%, 12.34 ± 5.95, and 49.89 ± 8.98, respectively. A multiple linear regression analysis with GEE indicated that sleep time variability (B = 0.86, p = .001), and sleep quality (B = 2.36, p < .001) had negative effects on nurses’ PMS. We also found that sleep quality had a complete mediating effect in the relationship between occupational stress and PMS. @*Conclusion@#These findings indicate that both sleep time variability and sleep quality are important factors associated with PMS among shift work nurses. To improve shift nurses’ PMS status, strategies are urgently needed to decrease sleep time variability and increase sleep quality.

Secondary Data Analysis on the Quality of Sleep and Related Factors of Novice and Experienced Shift Work Nurses

Purpose@#The purpose of this study was to identify the quality of sleep in novice and experienced shift work nurses and compare the factors associated with their quality of sleep. @*Methods@#We analyzed the data of 192 and 256 novice and experienced nurses, respectively. The quality of sleep, sleep hygiene, job stress, and fatigue were measured using Insomnia Severity Index, Sleep Hygiene Practice Scale, the Korean Occupational Stress Scale, and Fatigue Severity Scale. Data were analyzed using SPSS 25.0 to calculate descriptive statistics and logistic regression. @*Results@#Sleep quality was lower in experienced nurses (12.55 ± 5.71) than in novice nurses (11.18 ± 5.78). Fatigue was more severe in experienced nurses (4.47 ± 1.13) than in novice nurses (4.23 ± 1.12). In the logistic regression, factors related to sleep quality in novice nurses were sleep hygiene (odds ratio; OR = 1.06, p < .001) and fatigue (OR = 2.49, p < .001). Factors related to sleep quality in the experienced nurses were also sleep hygiene (OR = 1.04, p = .001) and fatigue (OR = 1.53, p = .012). @*Conclusion@#Sleep quality of experienced nurses is lower than those of novice nurses. Factors associated with sleep quality in novice and experienced nurses are equally identified as sleep hygiene and fatigue. Therefore, personal efforts to improve sleep hygiene, such as providing comfortable sleep environment, are needed. Furthermore, organized efforts to decrease fatigue, such as constructing a working environment with a bright light at night and providing a fatigue-decreasing program that includes meditation, are required.

Predictors of Blood and Body Fluid Exposure and Mediating Effects of Infection Prevention Behavior in Shift-Working Nurses: Application of Analysis Method for Zero-Inflated Count Data

Purpose@#This study aimed to identify the predictors of blood and body fluid exposure (BBFE) in multifaceted individual (sleep disturbance and fatigue), occupational (occupational stress), and organizational (hospital safety climate) factors, as well as infection prevention behavior. We also aimed to test the mediating effect of infection prevention behavior in relation to multifaceted factors and the frequency of BBFE. @*Methods@#This study was based on a secondary data analysis, using data of 246 nurses from the Shift Work Nurses’ Health and Turnover study. Based on the characteristics of zero-inflated and over-dispersed count data of frequencies of BBFE, the data were analyzed to calculate zero-inflated negative binomial regression within a generalized linear model and to test the mediating effect using SPSS 25.0, Stata 14.1, and PROCESS macro. @*Results@#We found that the frequency of BBFE increased in subjects with disturbed sleep (IRR = 1.87, p = .049), and the probability of non-BBFE increased in subjects showing higher infection prevention behavior (IRR = 15.05, p = .006) and a hospital safety climate (IRR = 28.46, p = .018). We also found that infection prevention behavior had mediating effects on the occupational stress-BBFE and hospital safety climate-BBFE relationships. @*Conclusion@#Sleep disturbance is an important risk factor related to frequency of BBFE, whereas preventive factors are infection prevention behavior and hospital safety climate. We suggest individual and systemic efforts to improve sleep, occupational stress, and hospital safety climate to prevent BBFE occurrence.

Nutritional Status of Liver Transplantation Recipients and Factors Influencing Nutritional Status

PURPOSE@#This study aimed to investigate the nutritional status of liver transplantation (LT) recipients and explore certain factors that influence nutritional status, including dietary patterns and physical activities.@*METHODS@#This was a cross-sectional, descriptive study. The subjects included 211 LT recipients at a medical center outpatient clinic located in Seoul, Korea. The nutritional status, dietary patterns, and physical activities of each subject were measured using the body mass index (BMI), Mini Dietary Assessment (MDA), and Global Physical Activity Questionnaire. Independent t-test, one-way analysis of variance, and multiple linear regression analysis were used to analyze the data.@*RESULTS@#The percentages of living and deceased donor LTs were 81.0% and 19.0%, respectively. The mean BMIs pre- and post-LT were 23.88 and 23.16 kg/m2, respectively, and the average MDA score was 36.55. More than 60.0% of the subjects had a moderate or high level of physical activity. In multivariate analysis, a higher BMI before LT (β=.72, p<.001), a lower Model for End-stage Liver Disease (MELD) score (β=−.18, p<.001), and being male (β=−.10, p=.024) contributed to better nutritional status post-LT. Patients within six months of LT were less engaged in muscle exercises than those post six months of LT (p=.020).@*CONCLUSION@#LT recipients in Korea have good nutritional status and a good level of physical activity. To improve recipients' post-LT nutritional status, the pre-LT nutritional status should be considered, particularly in those with a higher MELD score. In addition, physical activity including muscle-strengthening exercises should be encouraged from an earlier stage.

Health Promoting Behavior and Factors in Operating Room nurses

PURPOSE: This study aimed to investigate the level and related factors related to health-promoting lifestyle in operating room nurses in Korea.METHODS: A cross-sectional descriptive survey design was employed. The data were collected using questionnaire for three weeks in December 2018 from 110 operating room nurses working for more than six months in a general hospital located in Seoul. The Health Promoting Lifestyle Profile-II, The Korean Version of the Practice Environment Scale of Nursing Work Index, and Operating nurse's Job stress Factor Scale were used.RESULTS: Significant relationships were observed between health promoting lifestyle and educational level(p=.025), perceived economic status (p=.001) wearing a lead apron for protection from radiation during the operation(p < .001), work satisfaction(p=.016), and fatigue related to work(p=.006). Also significant correlations were identified between nursing work environment and health promoting lifestyle. However, the health promoting lifestyle was not statistically different based on occupational stress(p=.365). In multiple linear regression analyses, the level of health promoting lifestyle found to be higher in subjects who did not wear a lead apron for protection from radiation(p=.017), and who had more positive perception of the nursing work environment(p=.034).CONCLUSION: In order to increase health promoting lifestyle of operating nurses, the strategies to improve the nursing work environment are essential.

Effects of a Laughter Therapy on Depression, Anxiety, Fatigue and Quality of Sleep in Gastrointestinal Cancer Patients Post-Treatment: a Randomized Controlled Trial

PURPOSE: The purpose of this study was to examine the effect of laughter therapy on depression, anxiety, fatigue, and quality of sleep in gastrointestinal cancer survivors. METHODS: This study was a randomized controlled trial. We compared the effect of laughter therapy with usual care only in post chemotherapy gastrointestinal patients. Outcomes included changes in depression and anxiety (according to the Hospital Anxiety and Depression Scale), fatigue (according to the Fatigue Severity Scale), and quality of sleep (according to the Verran & Synder-Halpern Sleep Scale). Data was collected July 2015 through January 2016. Seventy nine participants who agreed to participate in this study were randomized to either the experimental group (n=40) or the control group (n=39). Therapy included eight sessions (60 minutes each, once weekly). Data were analyzed using the Windows SPSS 22.0 program. RESULTS: Laughter therapy was effective in reducing fatigue (p=.019) and increasing satisfaction of sleep (p=.030). There were no differences between the groups after therapy for depression (p=.129) and anxiety (p=.200). CONCLUSION: Results of this study indicate that laughter therapy may be an effective nursing intervention for improving the health status of gastrointestinal cancer survivors after chemotherapy.

Nutritional Status of Liver Transplantation Recipients and Factors Influencing Nutritional Status

PURPOSE: This study aimed to investigate the nutritional status of liver transplantation (LT) recipients and explore certain factors that influence nutritional status, including dietary patterns and physical activities. METHODS: This was a cross-sectional, descriptive study. The subjects included 211 LT recipients at a medical center outpatient clinic located in Seoul, Korea. The nutritional status, dietary patterns, and physical activities of each subject were measured using the body mass index (BMI), Mini Dietary Assessment (MDA), and Global Physical Activity Questionnaire. Independent t-test, one-way analysis of variance, and multiple linear regression analysis were used to analyze the data. RESULTS: The percentages of living and deceased donor LTs were 81.0% and 19.0%, respectively. The mean BMIs pre- and post-LT were 23.88 and 23.16 kg/m2, respectively, and the average MDA score was 36.55. More than 60.0% of the subjects had a moderate or high level of physical activity. In multivariate analysis, a higher BMI before LT (β=.72, p<.001), a lower Model for End-stage Liver Disease (MELD) score (β=−.18, p<.001), and being male (β=−.10, p=.024) contributed to better nutritional status post-LT. Patients within six months of LT were less engaged in muscle exercises than those post six months of LT (p=.020). CONCLUSION: LT recipients in Korea have good nutritional status and a good level of physical activity. To improve recipients' post-LT nutritional status, the pre-LT nutritional status should be considered, particularly in those with a higher MELD score. In addition, physical activity including muscle-strengthening exercises should be encouraged from an earlier stage.

The Effect of Methylphenidate on the Hearing of Children with Attention Deficit Hyperactivity Disorder

Abstract Introduction There has been a sudden idiopathic hearing loss case presented after methylphenidate treatment in a child with attention deficit hyperactivity disorder (ADHD). Objective This study was performed to reveal the probable ototoxic side effects of methylphenidate use in patients with ADHD. Methods Thirty pediatric patients with ADHD were included in the study. Pure tone audiometry, speech discrimination scores, waves I, III, V absolute latencies and waves IIII, I-V, III-V interpeak latencies at the 80 dB nHL intensity after click stimulus auditory brainstem response (ABR) results were compared before and 3 months after methylphenidate treatment. Results There were no statistically significant difference between pretreatment and posttreatment pure tone and speech audiometry findings and ABR results (p > 0.05 for all parameters). Conclusion Methylphenidate can be regarded as a safe drug regarding ototoxic side effects. Additional studies with a larger sample size and longer follow-up may be needed.