Risk and Risk Factors for Postpartum Type 2 Diabetes Mellitus in Women with Gestational Diabetes: A Korean Nationwide Cohort Study

Background@#There are differences in risk and risk factor findings of postpartum type 2 diabetes mellitus (T2DM) after gestational diabetes depending on study design and subjects of previous studies. This study aimed to assess these risk and risk factors more accurately through a population-based study to provide basic data for prevention strategies. @*Methods@#This open retrospective cohort included data of 419,101 women with gestational diabetes and matched 1,228,802 control women who delivered between 2004 and 2016 from the South Korea National Health Information Database of the National Health Insurance Service. Following 14 (median 5.9) years of follow-up, the incidence and hazard ratio (HR) of postpartum T2DM were evaluated using Kaplan-Meier curves and Cox proportional regression models. @*Results@#The incidence and HR of postpartum T2DM in women with gestational diabetes (compared to women without gestational diabetes) after the 14-year follow-up was 21.3% and 2.78 (95% confidence interval [CI], 2.74 to 2.82), respectively. Comorbid obesity (body mass index [BMI] ≥25 kg/m2) increased postpartum T2DM risk 7.59 times (95% CI, 7.33 to 7.86). Significant risk factors for postpartum T2DM were fasting glucose level, BMI, age, family history of diabetes, hypertension, and insulin use during pregnancy. @*Conclusion@#This population-based study showed higher postpartum T2DM risk in women with gestational diabetes than in those without, which was further increased by comorbid obesity. BMI and fasting glucose level were important postpartum risk factors. The management of obesity and glycemic control may be important strategies to prevent the incidence of diabetes after delivery.

An Estimation of Supply and Demand for Primary Healthcare Nursing Workforce in the North Korean Region after Korean Reunification / 간호행정학회지

PURPOSE: This study was done to estimate supply and demand for nursing workforce to provide community-based primary healthcare in the North Korean region to cost-efficiently narrow the health gap between the two Koreas in case of a Korean reunification. METHODS: To understand the nursing education system and current state of nursing workforce in North Korea, the authors interviewed six North Korean defectors who had worked as nurses in North Korea. Based on the interview results and literature review, the supply and demand for the primary healthcare nursing workforce that would be needed after Korean reunification were estimated RESULTS: Currently, a total of 2,100 to 2,700 North Korean nurses were estimated to have graduated from nursing schools with a 2 year curriculum or completed 6-month military nurse training courses every year. The projected number of nurses in demand to provide primary health care ranged from 84,160 to 105,200 and the shortage would be between 31,586 and 52,626. CONCLUSION: An active utilization of the North Korean nursing workforce to improve the health of North Koreans after reunification will be the best way to reduce the reunification cost which will be inflicted mainly on South Korea.

Pregnant Women's Labor Progress, Childbirth Outcome, and Childbirth Satisfaction according to the Presence or Absence of Labor Induction

PURPOSE: To provide accurate information on induced labor and find strategies to enhance women's childbirth satisfaction. METHODS: Participants were pregnant women expected to have normal vaginal delivery. A total of 113 women with induced labor and 61 women with spontaneous labor were surveyed. Data were collected using a questionnaire and electronic medical records. RESULTS: The following variables related to labor progress showed significant differences between the induced labor group and the spontaneous labor group: length of the first stage of labor in primigravidas, use of analgesic, incidence of uterine hyperstimulation, incidence of fetal distress, and medical treatment for the expectant mother. Delivery type and the incidence of postpartum complications showed significant difference between the two groups. Induced labor women's childbirth satisfaction was mainly affected by the process of labor whereas spontaneous labor women's childbirth satisfaction was affected by the outcome of childbirth. CONCLUSION: Medical staff should have accurate information on the risk of induced labor and the benefits of a natural delivery. Moreover, medical staff should provide necessary information and environment for women to participate in the decision-making process.

Delivery Room Nurses' Experiences of Caring for Stillborn Babies and Their Parents

PURPOSE: The purpose of the study was to have an in-depth understanding of delivery room nurses'experiences of caring for stillborn babies and their parents. METHODS: After obtaining approval from the Institutional Review Board, data were collected from March 1 to August 30, 2016. A total of six nurses participated in the study. Semi-structured in-depth interviews were conducted and the data subsequently analyzed. RESULTS: Using thematic analysis, six themes were defined and refined: Emotional distress as a result of encountering stillborn babies; Caring for the deceased baby; Concerns for the mother's pain; Consideration for the father; Conflicts between accepting and dismissing parents' requests; and Strong mindset for the stillborn babies and their parents. CONCLUSION: The results showed that the nurses' experiences of caring for stillborn babies and their parents might be a difficult and lonely process. However, it could also be a process of attaining maturity by finding meaning and value in one's work. It would be helpful for the delivery room nurses to share examples of effective communication, train through simulation, and learn useful strategies that each nurse can use.

Health Behaviors and Risk Factors Associated with Chronic Kidney Disease in Korean Patients with Diabetes: The Fourth Korean National Health and Nutritional Examination Survey

PURPOSE: The purpose of this study was to identify health behavior and risk factors for chronic kidney disease (CKD) in Korean patients with diabetes. METHODS: This study was a secondary analysis of the Fourth Korean National Health and Nutritional Examination Survey (2007-2009). Of the 24,871 participants, 1,239 aged over 19 years with diagnosis of diabetes were included. Stratified and cluster variables in the analysis-plan file for a weighted, complex sample were analyzed. CKD was confirmed by the estimated glomerular filtration rate level of 15.0-59.9 mL/min/1.732 m2. Odds ratios between the variables and CKD were calculated using logistic regression analysis with adjustment for gender, age, educational background, income, and duration of diagnosis. RESULTS: The results showed that 14.7% of participants with diabetes were accompanied with CKD. The risk of developing CKD in those who made efforts to take proper nutrition but failed was 1.76 times higher than those taking nutrition properly. In those who used to smoke compared to their nonsmoking counterparts, the risk was 2.06 times higher; in those who did not do vigorous exercise compared to those who did, the risk was 2.12 times higher; in those with hypertension than those without, the risk was 2.4 times higher; and in those with anemia compared to those without, the risk was 2.32 times higher. Only 19% of the participants received health education for diabetes, which did not affect the incidence of CKD. CONCLUSION: Since renal functions are affected by lifestyle factors, it is critical for healthcare professionals to provide diabetic patients with health education focused on changing their behavior so that it is conducive to health. It is also necessary to consider that diabetes education should be made more available and provided more effectively to these patients.

Factors of Prenatal Depression by Stress-vulnerability and Stress-coping Models

PURPOSE: This study aimed to identify related factors of prenatal depression by stress-vulnerability and stress-coping models for pregnant women. METHODS: A cross-sectional survey design with a convenience sampling was used. A total of 107 pregnant women who visited a general hospital in a metropolitan city were recruited from August to October, 2013. A structured questionnaire included the Korean version of Beck Depression Inventory II, and the instruments measuring Self-Esteem, Marital Satisfaction, Pregnancy Stress, Stressful Life Events, and Coping. The data were analyzed using descriptive statistics, t-test, Parson's correlation analysis, and stepwise multiple regression. RESULTS: The mean score of prenatal depression was 11.95+/-6.2, then showing 19.6% with mild depression, 15.0% with moderate depression, and 0.9% with severe depression on BDI II scale. Prenatal depression had positive correlation with pregnancy stress (r=.55, p<.01), stressful life events (r=.26, p<.01) and negative correlation with self-esteem (r=-.38, p<.01), marital satisfaction (r=-.40, p<.01), and coping (r=-.21, p<.05). Factors of pregnancy stress, self-esteem, stressful life events, and planned pregnancy explained 38% of the total variance of prenatal depression. CONCLUSION: These findings show that health providers need to assess prenatal depression and to control the influencing factors.

Structural Equation Modeling on Contraception Behavior of Unmarried Men and Women in Korea: Gender Difference

PURPOSE: The purpose of this study was to test and validate a model to predict contraception behavior in unmarried men and women. METHODS: Data were collected from a questionnaire survey of 180 unmarried men and 186 unmarried women 20 years of age or over who had sexual relationships in the past 6 months. Participants were from Seoul, Kyunggi, Daegu, and Busan and data collection was done from February 19 to April 16, 2013. RESULTS: Model fit indices for the hypotheoretical model fitted to the recommended levels. Out of 15 paths, 11 were statistically significant in both. Predictors of contraception behavior in unmarried men and women were intention to use contraception and self-efficacy for contraception. Exposure to sexual content was directly significant to the intention in men only. Self-efficacy for contraception was affected by perceived threat of pregnancy and gender role attitude. In women, the two predictors were also significant except for the effect of exposure to sexual contents. CONCLUSION: Results indicate that an intervention program which increases self-efficacy in unmarried men and women contributes to effective contraception behavior. In addition, proper sexual education programs using positive aspect of mass media can help develop active participation for contraception behavior.

Effects of Body Weight Control Behaviors on Bone Mineral Density in Korean Young Adult Women

PURPOSE: This study identified the effects of body weight control behaviors on bone mineral density (BMD) in Korean women aged 20 to 39 years. METHODS: A secondary analysis of the 5th Korean National Health and Nutrition Examination Survey was conducted. Asian-Pacific criteria of BMI (Body Mass Index) and BMD were calculated for 1,026 women selected. The effects of body weight control behaviors were assessed using binary multiple logistic regression analysis while controlling for BMI. RESULTS: Osteopenia and osteoporosis rates were 32.8% and 2.0%, respectively. About 69% of women performed weight control behaviors, and a combination of diet/exercise (22.7%) and drug added methods (10.9%) for weight control. Women who performed both diet control and exercise had a lower possibility to have abnormal BMD than those who did not try weight control (OR=0.67, CI=0.45~0.98, p=.039). Further weight control behaviors did not influence abnormal BMD. CONCLUSION: Body weight control should include proper diet and exercise in accordance with each woman's BMI level.

Depression of Married and Employed Women Based on Social-Role Theory

PURPOSE: This study was based on social-role theory, and purposes were to investigate (1) how depression and health determinants vary with married and employed women, and (2) what factors contribute to depression according to family cycle. METHODS: A stratified convenience sample of 765 married and employed women was recruited during May to August 2010. Study variables of depression, socio-demographic threatening factors, psycho-stimulating factors, and social-role related factors were measured via a structured questionnaire. RESULTS: Prevalence rate for depression was 18.6%, with highest rate (25.4%) from elementary laborers. Greater levels of depression were related to women's occupation, higher life stress, and poorer health; lower social support and vulnerable personality; higher levels of social-role related stress. From multivariate analysis, women with preadolescents were the most vulnerable to depression affected by occupation, life stress, personality, and parenting stress. These factors (except for occupational class) combined with economic status, social support, and housework unfairness were significant for depression in women with adolescents. CONCLUSION: Depression among married and employed women differs by psycho-stimulating and social role relevant factors in addition to occupational class and family life cycle. Female elementary laborers and women with children need to have the highest prioritization for community mental health programs.

Details of Lymphedema, Upper Limb Morbidity, and Self Management in Women after Breast Cancer Treatment / 여성건강간호학회지

PURPOSE: To examine the details of lymphedema, upper limb morbidity, and its self management in women after breast cancer treatment. METHODS: Using a cross-sectional survey design, 81 women were recruited from a university hospital. Lymphedema was detected by a nurse as a 2-cm difference between arm circumferences at 6 different points on the arm. Degrees of pain, stiffness, and numbness were scored using a drawing of upper limb on a 0~10 point scale. Aggravating conditions and self-management for lymphedema were also recorded. RESULTS: The mean age of the participants was 52.5 years; the average time since breast surgery was 29.7 months. Histories of modified radical mastectomy (55%) and lymph node dissection (81%) were noted. Lymphedema was found in 59% of women, then pain and stiffness were prevalent most at upper arm while numbness was apparentat fingers, and the symptom distress scores ranged 3.9~6.7. Women experienced aggravated arm swelling after routine housework with greatly varied duration. Self-management was conservative with a wide range of times for the relief of symptoms. CONCLUSION: Lymphedema education for women with breast cancer should be incorporated into the oncologic nursing care system to prevent its occurrence and arm morbidity. Risk reduction guidelines, individually tailored self-care strategies, and self-awareness for early detection need to be refined in clinical nursing practices.

Contraception Behavior and Related Factors in Unmarried Female and Male / 여성건강간호학회지

PURPOSE: This study aimed to identify differences in contraception behavior and related factors between unmarried female and male. METHODS: A cross-sectional survey design with a convenient sampling was used. From Seoul, 107 women and 96 men were recruited. A structured questionnaire was self-administered from July 14, 2008 to September 2, 2008. RESULTS: The average ages of women and men were 26.9 and 27.8 years old, respectively. Fifty-six percent of women and 85.4% of men have experienced sexual intercourse. There were no differences between female and male in attitude toward contraception, subjective norm, and contraception behavior, while female had higher score of self-efficacy for contraception (p=.02) and intention of contraception (p=.02). There was positive correlation with subjective norm (r=.22, p<.05), self-efficacy (r=.53, p<.01) in male and attitude (r=.32, p<.05), self-efficacy (r=49, p<.01) in female. According to the result of multiple regression, the significant factor of contraception behavior was self-efficacy for both female (beta=.49, p=.00) and male (beta=.53, p=.00). CONCLUSION: To improve contraception behavior for unmarried female and male, it is necessary to develop proper sex education program to enhance self-efficacy for contraception. Adjusted education program by this result will contribute to increase sexual health for female and male.

Student Experience and Satisfaction with Clinical Nursing Practice in Women's Health Nursing / 여성건강간호학회지

PURPOSE: The purpose of this study was to identify students' experiences of performance and their satisfaction with clinical nursing practice in Women's health nursing. METHODS: Data was collected using questionnaire consisting of 104; 89,; and 82 nursing activities with 12; 10; and 7 domains for delivery floor, obstetric, and gynecologic wards retrospectively. Five hundred ninety nursing students from 10 four year and one three year colleges, were recruited and selected for data collection. RESULTS: Site specific core nursing activities among top 15 items of performed experience were: interpreting fetal monitoring; massage for pain reduction; breathing technique; perineal pad change; non stress test; manual check for uterine contraction; and position change for the delivery floor. Experiences of clinical nursing practice for the obstetric ward and the gynecologic ward were identified and ranked as well. Observation of delivery, measurement & test during labor and observation of anesthesia and operation were the highest ranked activity domains of satisfaction for delivery floor, obstetric and gynecologic wards retrospectively. CONCLUSION: Discussions are needed to standardize curriculum for clinical practice in women's health nursing initiated at the level of Korean Society of Womens' Health Nursing by reflecting this result. Strategic approaches are emphasized in order to enhance a collaboration between clinical fields and colleges.

Grandmother's Life Satisfaction and Influencing Factors by Grandparenting / 여성건강간호학회지

PURPOSE: The study was to compare the factors of life satisfaction between grandmothers parenting and not parenting their grandchildren. METHODS: A descriptive design with a convenience sampling was used for this study. From communities in S and U city, 85 parenting grandmothers (PG) and 103 non-parenting grandmothers (NPG) were recruited. The PG were those grandmothers who cared for preschooler grandchildren for their daughter or daughter-in-law who was employed. RESULTS: The demographics of the two groups were similar, however the value of grandparenting was significantly higher in the PG than the NPG (t=4.56, p<.001). In the PG, strong and significant correlations were found among the value of grandparenting, health status, quality of relations with adult children, and life satisfaction. However, demographics were more related to health status and life satisfaction in the NPG. The value of grandparenting, health status, and quality of grandmother-adult children relations were found to be significant factors of life satisfaction (F=20.75, p<.001) explaining 42% of the variances. In the NPG, only health status was a significant factor (F=50.66, p<.001) explaining 33% of the variances. CONCLUSION: This study shows that grandmothers' perceptions of grandparenting and family relationships need to be incorporated into the lifestyle in order to support parenting grandmothers' life satisfaction while grandmothers' health is the common concern of elderly women's life satisfaction.

Effects on Nursing Students of Cognition-Behavior Integrated Breast Cancer Prevention Education Using an Interchangeable Nodule Model / 여성건강간호학회지

PURPOSE: The study was done to examine the effects of cognition-behavior integrated breast cancer prevention education, in which a breast model with interchangeable nodules was utilized, on the self-competency of nursing students in performing breast cancer education. METHODS: A nonequivalent control group non-synchronized design was used. A traditional lecture intervention was provided for 49 3rd year college of nursing students (control group) while the integrated breast cancer prevention education was given to 47 3rd year students in the same college one year later (experimental group). The integrated breast cancer prevention education was developed by the research team to strengthen the competency of cognitive and behavioral components in education on breast cancer. RESULTS: Effects of the intervention were found to be significant through all study variables: knowledge about breast cancer (t=7.79, p <.001), breast cancer risk awareness (t=2.05, p <.05), self-competency of breast self-exam (t=8.27, p <.001), and intention to teach breast self-exam (t=3.87, p <.001). CONCLUSION: The integrated breast cancer prevention education was useful to improve not only knowledge about breast cancer but competency in performing breast examination for nursing students who acquired technical skills from various simulation nodules. As the program helped the students to be prepared as confident educators, future application of the module is recommended for academic curricula.

Factors of Physical and Psychological Symptoms in Women after Miscarriage / 여성건강간호학회지

PURPOSE: The study aimed to explore the health consequences that women experienced after miscarriage and the factors related to them. METHODS: A convenience sample consisting of 102 women who had miscarried within 2 years was used. Women were recruited from hospitals and enterprises in Seoul and Gyeong-Gi Province. Participants completed a self-administered questionnaire containing a physical and psychological symptoms checklist developed for this study. RESULTS: More than 40% of the miscarriages occurred after 9 weeks of pregnancy and 35% of women were found to have had a previous miscarriage prior to this study. Psychological symptoms were more prevalent and prolonged than the physical symptoms, furthermore, the frequencies of the symptoms experiencedwere not consistent with the duration of symptoms. Employed women and women with early miscarriages complained of more physical symptoms; however, psychological symptoms were not different according to women's characteristics. Employment was a significant factor affecting physical symptoms. CONCLUSION: Health care professionals need to inform and educate women and the family of the potential health changes during the recovery after the miscarriage. Health consequences due to miscarriages also need to be incorporated in women's reproductive health care. Nursing care should consider factors of maternal age, employment status, and obstetrical conditions upon the apparent social changes.

Development of a "Grandmothering Stress Index" for Korean Day-care Grandmothers / 여성건강간호학회지

PURPOSE: The study was to develop an instrument to measure grandmothering stress for Korean day-care grandmothers and to test the validity and reliability of the instrument. METHOD: The items of the instrument were based on a literature review and secondary data. After content validity tests and a pilot test, 20 items were developed. In order to test the reliability and validity of the scale, data were collected from 126 grandmothers. RESULT: After a factor analysis, five factors and 15 items were selected. These explained 67.2% of the total variance. The first domain was termed 'Health problems', and explained 18.1% of the total variance, and the second domain of 'Possibility of role substitution' explained 13.8%. The third and the fourth domains were 'Relations with adult children' and 'Grandchildren's characteristics' explaining 12.5% and 12.1%, respectively. The last domain explained 10.8% of the total variance with the theme 'Restriction of social life'. After accomplishing the reliability analysis, Cronbach's alpha coefficient was determined to be .75. CONCLUSIONS: This initial step in the development of a Grandmothering Stress Index is valuable to reflect the subject of Grandmothering stress in senior citizens in Korea. Future study should to refine the constitution of the instrument.

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.

Analysis of Published Papers and their Keywords in the Korean Journal of Women Health Nursing (2003-2006) / 여성건강간호학회지

PURPOSE: This research was aimed to explore the major subjects and research theme and to classify characteristics of the key words in recent Korean Journal of Women Health Nursing. METHOD: With survey design, whole 103 published papers during 2003-2006 were analyzed with structured analysis form; research subjects, research methodology, data analysis, and key words of the published papers were classified and extracted. Various theme was founded and classified to 9 domains. RESULT: Most of the research subjects were women. Eighty-eight percent of papers conducted quantitative research; 83% chose convenience sampling and 69% used survey design, while experimental design was 29%. Key words were categorized 9 domains: demographic, health related concept, health behavior(intervention), sex-related, life event, disease, et al. Among 9 domains, health related concept, especially psycho-social topics such as depression, anxiety, stress were mostly studied and then physiologic topics such as labor pain, fatigue, and menstrual symptoms. CONCLUSION: Most of the subjects were women and the most common domain studied was health related concepts in Korean Journal of Women Health Nursing. And key words and topics were on women's health issues. We can conclude that Korean Journal of Women Health Nursing has published by her own philosophy.

Application of Problem-Based Learning(PBL) for Students' Practice in Maternity Nursing / 여성건강간호학회지

PURPOSE: This study was done to apply a PBL module for students' practice in maternity nursing. METHOD: Two PBL module scenarios were made for clinical cases in antepartum, intrapartum, and postpartum nursing care. A total of 70 senior nursing students of S university were enrolled in this module for their scheduled 3 weeks of practice. A structured questionnaire and subjective statements were collected for evaluation. RESULT: The students' perceptions of PBL were found to be effective in encouraging motivation and interest in studying, absorbing practical knowledge better, and learning through interaction with tutors. They became more confident, active, and positive throughout the PBL experiences while a lack of time for learning was a limitation. CONCLUSION: PBL is considered a method that can strengthen nursing students' abilities to adjust to clinical situations in maternity areas. It is recommended to expand PBL in nursing practice courses and develop various scenarios and qualified tutors.

Breast Cancer Screening Behaviors in Working Women / 여성건강간호학회지

PURPOSE: The aim of this study was to analyze breast cancer screening behaviors in working women. METHOD: A total of 354 women over 20 years of age were recruited from three major occupational settings by convenience sampling. The Champion's Health Beliefs Model Scale-Korean version and a structured questionnaire for measuring regularity and accuracy of breast self-examination(BSE) were used. Data were analyzed using descriptive statistics, chi-square-test, ANOVA, and Duncan post hoc tests. RESULT: Women who have performed BSE and had both BSE and clinical tests were 49.2% and 32.8%, respectively, while 36.7% of the participants had none of the screening. The screening patterns were significantly different by individual characteristics of age, occupation, experiences of breast disease, education at workplace, and by the level of confidence in health beliefs (p<.01, p<.05). Only 4 % of women performed BSE regularly and the level of accuracy of the BSE was very low as well. CONCLUSION: Education at the workplace needs to emphasize the recommended guidelines and further increase the quality and results of the BSE for women's health.