A Systematic Review of the Effects of Aromatherapy on Depression and Anxiety in Postmenopausal Women

Purpose@#This systematic review aimed to investigate the effects of aromatherapy interventions on depression and anxiety in menopausal women. @*Methods@#This study adhered to PRISMA (preferred reporting items of systemic reviews and meta-analysis) guidelines. Relevant studies published between 1994 and 2002 were searched in PubMed, Embase, Cochrane Library, CINAHL, Google Scholar, DBPIA, KISS, and RISS databases. Search criteria included the mesh terms 'aromatherapy menopause women depression anxiety.' The review included randomized and nonrandomized studies of women who were menopausal or postmenopausal and received aromatherapy intervention for depression and anxiety associated with symptoms of menopause. The extracted literature was evaluated via quality appraisal checklists of ROB 2 (Risk of Bias 2.0) and ROBINS-1 (Risk Of Bias In Non-Randomized Studies - of Interventions) and visualized using a risk-of-bias visualization tool. @*Results@#The review included 6 randomized controlled studies and 2 quasi-experimental studies. The results showed that aromatherapy massage and inhalation therapy were effective in reducing depression and had beneficial effects in reducing anxiety, improving quality of sleep, and menopausal symptoms in menopausal women. @*Conclusion@#Interventions using aromatic essential oils to massage the hands, arms, back, and scalp or inhalation of aromatic oils from clothing, necklaces, and bedding might be beneficial for the emotional health of menopausal women. Women health professionals should consider applying aromatherapy to menopausal women to improve emotional health, sleep, and menopausal symptoms.

Development and Evaluation of Prenatal Education for Environmental Health Behavior Using Cartoon Comics

Purpose@#This study aimed to develop and examine the effects of a prenatal program on environmental health behavior using cartoon comics among Korean pregnant women. @*Methods@#This study used a non-equivalent control group pre-test/post-test design. The program used cartoon comics to explore environmental health behaviors during pregnancy. The program consisted of the following four components: environmental toxicants during pregnancy, avoiding particulate matter during pregnancy, environmental toxicants during baby care, and making a healthy environment for children. In total, 35 pregnant women participated in the study: 18 in the experimental group and 17 in the control group. Data collection and program adaptation were conducted between November 3, 2020 and January 19, 2021. The effect of the prenatal education program was evaluated by t-test and repeated measures ANOVA. @*Results@#Learning experience (t = - 2.35, p = .025), feasibility (t = - 2.46, p = .019), satisfaction (t = - 2.23, p = .032) were higher in the experimental group than in the control group in the first post-test. Feasibility (t = - 2.40, p = .022) was higher in the experimental group than in the control group in the second post-test. Repeated-measures ANOVA showed significant interactions between time and group in environmental susceptibility (F = 9.31, p < .001), self-efficacy (F = 3.60, p = .033), and community behavior (F = 5.41, p = .007). @*Conclusion@#This study demonstrates the need for a prenatal education program to promote environmental health perceptions and behavior during pregnancy. We suggest a prenatal class adopting the creative cartoon comics to promote the maternal environmental health behaviors.

Birth cohort effects on maternal and child environmental health: a systematic review

Purpose@#This study aimed to review recent findings from birth cohort studies on maternal and child environmental health. @*Methods@#Birth cohort studies regarding environmental health outcomes for mothers and their children were investigated through a systematic review. A literature search was conducted in PubMed, CINAHL, the Cochrane Library, Embase, and RISS to identify published studies using the keywords “((“Maternal Exposure”[Mesh] OR (“C”[TW] OR “Maternal Exposures” OR “Prenatal Exposures”[TW])) AND “Environmental Exposure”[Mesh] AND “Health”[Mesh] AND (“Cohort Studies”[Mesh] OR “Cohort”[TW] OR “Birth Cohort”[TW]).” Articles were searched and a quality appraisal using the Newcastle-Ottawa Scale for cohort studies was done. @*Results@#A review of the 14 selected studies revealed that prenatal and early life exposure to environmental pollutants had negative impacts on physical, cognitive, and behavioral development among mothers and children up to 12 years later. Environmental pollutants included endocrine disruptors, air pollution (e.g., particulate matter), and heavy metals. @*Conclusion@#This systematic review demonstrated that exposure to environmental pollutants negatively influences maternal and children’s environmental health outcomes from pregnancy to the early years of life. Therefore, maternal health care professionals should take steps to reduce mothers’ and children’s exposure to environmental pollutants.

Development and validation of women’s environmental health scales in Korea: severity, susceptibility, response efficacy, self-efficacy, benefit, barrier, personal health behavior, and community health behavior scales

Purpose@#This study aimed to develop the following scales on women’s environmental health and to examine their validity and reliability: severity, susceptibility, response efficacy, self-efficacy, benefit, barrier, personal health behavior, and community health behavior scales. @*Methods@#The item pool was generated based on related scales, a wide literature review, and in-depth interviews on women’s environmental health according to the revised Rogers’ protection motivation theory model. Content validity was verified by three nursing professionals. Exploratory factor analysis, convergent validity, and internal consistency reliability were examined. @*Results@#The scales included 10 items on severity, 11 on susceptibility, 10 on response efficacy, 14 on self-efficacy, 8 on benefits, 10 on barriers, 17 on personal health behavior, and 16 on community health behavior. Convergent validity with the environmental behavior scale for female adolescents was supported. The Cronbach’s α values for internal consistency were good for all scales: severity, .84; susceptibility, .92; response efficacy, .88; self-efficacy, .90; benefits, .91; barriers, .85; personal health behavior, .90; and community health behavior, .91. @*Conclusion@#The evaluation of the psychometric properties shows that these scales are valid and reliable measures of women’s environmental health awareness and behaviors. These scales may be helpful for assessing women’s environmental health behaviors, thereby contributing to efforts to promote environmental health.

Development and Evaluation of Prenatal Education for Environmental Health Behavior Using Cartoon Comics

Purpose@#This study aimed to develop and examine the effects of a prenatal program on environmental health behavior using cartoon comics among Korean pregnant women. @*Methods@#This study used a non-equivalent control group pre-test/post-test design. The program used cartoon comics to explore environmental health behaviors during pregnancy. The program consisted of the following four components: environmental toxicants during pregnancy, avoiding particulate matter during pregnancy, environmental toxicants during baby care, and making a healthy environment for children. In total, 35 pregnant women participated in the study: 18 in the experimental group and 17 in the control group. Data collection and program adaptation were conducted between November 3, 2020 and January 19, 2021. The effect of the prenatal education program was evaluated by t-test and repeated measures ANOVA. @*Results@#Learning experience (t = - 2.35, p = .025), feasibility (t = - 2.46, p = .019), satisfaction (t = - 2.23, p = .032) were higher in the experimental group than in the control group in the first post-test. Feasibility (t = - 2.40, p = .022) was higher in the experimental group than in the control group in the second post-test. Repeated-measures ANOVA showed significant interactions between time and group in environmental susceptibility (F = 9.31, p < .001), self-efficacy (F = 3.60, p = .033), and community behavior (F = 5.41, p = .007). @*Conclusion@#This study demonstrates the need for a prenatal education program to promote environmental health perceptions and behavior during pregnancy. We suggest a prenatal class adopting the creative cartoon comics to promote the maternal environmental health behaviors.

Maternal Health Effects of Internet-Based Education Interventions during the Postpartum Period: A Systematic Review

Purpose@#This study aimed to investigate the maternal health effects of internet-based education interventions on parturients during the postpartum period through a systematic review of randomized controlled trials. @*Methods@#An electronic literature search of the Cochrane Library, CINAHL, EMBASE, Eric, PsycINFO, PubMed, RISS, and KISS databases was performed, using the combination of keywords such as ‘parenthood education’, ‘*natal education’, ‘*birth intervention’, ‘internet-based intervention’, ‘randomized controlled trial’. The inclusion criteria were peerreviewed papers in English regarding randomized controlled trials of internet-based postnatal education interventions. Educational interventions were delivered through any web, mobile, eHealth, mHealth, virtual reality, short message service, or social networking service platform. Quality appraisal was performed using the Risk of Bias 2 (RoB 2) for randomized controlled trials. Nine articles were yielded, and the intervention effects were analyzed. @*Results@#Internetbased education interventions during the postpartum period affect maternal self-efficacy, postpartum depression, and successive breastfeeding; however, they do not affect maternal satisfaction and parenting confidence. @*Conclusion@#This study demonstrated that internet-based education interventions affect maternal health status in terms of psychological, emotional, and physical wellness. Therefore, maternal health care professionals can utilize remote education using the internet or mobile-based interventions during the postpartum period.

Birth cohort effects on maternal and child environmental health: a systematic review

Purpose@#This study aimed to review recent findings from birth cohort studies on maternal and child environmental health. @*Methods@#Birth cohort studies regarding environmental health outcomes for mothers and their children were investigated through a systematic review. A literature search was conducted in PubMed, CINAHL, the Cochrane Library, Embase, and RISS to identify published studies using the keywords “((“Maternal Exposure”[Mesh] OR (“C”[TW] OR “Maternal Exposures” OR “Prenatal Exposures”[TW])) AND “Environmental Exposure”[Mesh] AND “Health”[Mesh] AND (“Cohort Studies”[Mesh] OR “Cohort”[TW] OR “Birth Cohort”[TW]).” Articles were searched and a quality appraisal using the Newcastle-Ottawa Scale for cohort studies was done. @*Results@#A review of the 14 selected studies revealed that prenatal and early life exposure to environmental pollutants had negative impacts on physical, cognitive, and behavioral development among mothers and children up to 12 years later. Environmental pollutants included endocrine disruptors, air pollution (e.g., particulate matter), and heavy metals. @*Conclusion@#This systematic review demonstrated that exposure to environmental pollutants negatively influences maternal and children’s environmental health outcomes from pregnancy to the early years of life. Therefore, maternal health care professionals should take steps to reduce mothers’ and children’s exposure to environmental pollutants.

Development and validation of women’s environmental health scales in Korea: severity, susceptibility, response efficacy, self-efficacy, benefit, barrier, personal health behavior, and community health behavior scales

Purpose@#This study aimed to develop the following scales on women’s environmental health and to examine their validity and reliability: severity, susceptibility, response efficacy, self-efficacy, benefit, barrier, personal health behavior, and community health behavior scales. @*Methods@#The item pool was generated based on related scales, a wide literature review, and in-depth interviews on women’s environmental health according to the revised Rogers’ protection motivation theory model. Content validity was verified by three nursing professionals. Exploratory factor analysis, convergent validity, and internal consistency reliability were examined. @*Results@#The scales included 10 items on severity, 11 on susceptibility, 10 on response efficacy, 14 on self-efficacy, 8 on benefits, 10 on barriers, 17 on personal health behavior, and 16 on community health behavior. Convergent validity with the environmental behavior scale for female adolescents was supported. The Cronbach’s α values for internal consistency were good for all scales: severity, .84; susceptibility, .92; response efficacy, .88; self-efficacy, .90; benefits, .91; barriers, .85; personal health behavior, .90; and community health behavior, .91. @*Conclusion@#The evaluation of the psychometric properties shows that these scales are valid and reliable measures of women’s environmental health awareness and behaviors. These scales may be helpful for assessing women’s environmental health behaviors, thereby contributing to efforts to promote environmental health.

Factors influencing suicidal ideation among female late adolescents from a Korean rural province

Purpose@#This study aimed to examine factors affecting suicidal ideation among female late adolescents from a Korean rural province. @*Methods@#A descriptive cross-sectional design involving self-reported questionnaires was used. The data were collected from 18- to 22-year-old female adolescents at high schools, universities, churches, and local community centers. The sample consisted of 197 female adolescents from three rural areas in Korea. The Center for Epidemiological Studies-Depression Scale and the Suicidal Ideation Scale were used to measure depression and suicidal ideation, respectively. @*Results@#Suicidal ideation was correlated with having a specific suicide plan (r=.65, p<.001), depression (r=.39, p<.001), and subjective well-being (r=–.46, p<.001). Factors affecting suicidal ideation among rural female adolescents were having a specific suicide plan (β=.56, p<.001), subjective well-being (β=–.23, p=.001), and suicide of a close person (β=.12, p=.035). These factors explained 48.0% of the variance in suicidal ideation (F=37.62, p<.001). @*Conclusion@#This study demonstrated that affective factors and personal experiences regarding suicide were critical indicators for preventing suicidal ideation among female adolescents. These factors should be managed among female adolescents, and tailored nursing interventions should be offered to enhance their psychiatric health status.

Development of the Cultural Competence Scale for Registered Nurses (CCS-RN)

PURPOSE: This study is to develop the Cultural Competence Scale for Registered Nurses (CCS-RN) and to examine its validity and reliability. METHODS: The item pool was generated based on related scales, a wide review of the literature, and in-depth interviews with nurses according to Purnell's cultural competence model. Content validity was verified by nursing experts. Construct validity using exploratory factor analysis, convergent validity using correlation coefficients, discriminant validity, internal consistency reliability, and test-retest reliability were examined. RESULTS: The CCS-RN consists of a 35-item/7-factor solution with 54.1% of the total variance explained. The convergent validity of CCS-RN was supported. Cronbach's α was .94 for the total scale and ranged from .77 to .90 for the seven factors. Test-retest reliability was moderate. CONCLUSION: The evaluation of the psychometric properties of the CCS-RN shows that this scale is expected to be a valid and reliable measure of cultural competence among nurses. This scale may be useful for assessing nurses' own cultural competence and thus contribute to strengthening cultural competence.

PI3Kδ contributes to ER stress-associated asthma through ER-redox disturbances: the involvement of the RIDD–RIG-I–NF-κB axis

Hyperactivation of phosphoinositol 3-kinase (PI3K) has been suggested to be a potential mechanism for endoplasmic reticulum (ER) stress-enhanced airway hyperresponsiveness, and PI3K inhibitors have been examined as asthma therapeutics. However, the regulatory mechanism linking PI3K to ER stress and related pathological signals in asthma have not been defined. To elucidate these pathogenic pathways, we investigated the influence of a selective PI3Kδ inhibitor, IC87114, on airway inflammation in an ovalbumin/lipopolysaccharide (OVA/LPS)-induced asthma model. In OVA/LPS-induced asthmatic mice, the activity of PI3K, downstream phosphorylation of AKT and activation of nuclear factor-κB (NF-κB) were all significantly elevated; these effects were reversed by IC87114. IC87114 treatment also reduced the OVA/LPS-induced ER stress response by enhancing the intra-ER oxidative folding status through suppression of protein disulfide isomerase activity, ER-associated reactive oxygen species (ROS) accumulation and NOX4 activity. Furthermore, inositol-requiring enzyme-1α (IRE1α)-dependent degradation (RIDD) of IRE1α was reduced by IC87114, resulting in a decreased release of proinflammatory cytokines from bronchial epithelial cells. These results suggest that PI3Kδ may induce severe airway inflammation and hyperresponsiveness by activating NF-κB signaling through ER-associated ROS and RIDD–RIG-I activation. The PI3Kδ inhibitor IC87114 is a potential therapeutic agent against neutrophil-dominant asthma.

Development of an Instrument to Assess the Quality of Childbirth Care from the Mother's Perspective

PURPOSE@#This study aimed to develop an instrument to assess the quality of childbirth care from the perspective of a mother after delivery.@*METHODS@#The instrument was developed from a literature review, interviews, and item validation. Thirty-eight items were compiled for the instrument. The data for validity and reliability testing were collected using a questionnaire survey conducted on 270 women who had undergone normal vaginal delivery in Korea and analyzed with descriptive statistics, exploratory factor analysis, and reliability coefficients.@*RESULTS@#The exploratory factor analysis reduced the number of items in the instrument to 28 items that were factored into four subscales: family-centered care, personal care, emotional empowerment, and information provision. With respect to convergence validation, there was positive correlation between this instrument and birth satisfaction scale (r=.34, p < .001). The internal consistency reliability was acceptable (Cronbach's alpha =.96).@*CONCLUSION@#This instrument could be used as a measure of the quality of nursing care for women who have a normal vaginal delivery.

Development of an Instrument to Assess the Quality of Childbirth Care from the Mother's Perspective

PURPOSE: This study aimed to develop an instrument to assess the quality of childbirth care from the perspective of a mother after delivery. METHODS: The instrument was developed from a literature review, interviews, and item validation. Thirty-eight items were compiled for the instrument. The data for validity and reliability testing were collected using a questionnaire survey conducted on 270 women who had undergone normal vaginal delivery in Korea and analyzed with descriptive statistics, exploratory factor analysis, and reliability coefficients. RESULTS: The exploratory factor analysis reduced the number of items in the instrument to 28 items that were factored into four subscales: family-centered care, personal care, emotional empowerment, and information provision. With respect to convergence validation, there was positive correlation between this instrument and birth satisfaction scale (r=.34, p < .001). The internal consistency reliability was acceptable (Cronbach's alpha =.96). CONCLUSION: This instrument could be used as a measure of the quality of nursing care for women who have a normal vaginal delivery.

Association of Anxiety, Depression, and Somatization with Menstrual Problems among North Korean Women Defectors in South Korea

OBJECTIVE: North Korean women defectors have suffered from anxiety, depression, and somatization after defection. Also they have had many menstrual problems like amenorrhea. This study was done to identify the correlations of anxiety, depression, and somatization to menstrual problems among North Korean woman defectors in South Korea. METHODS: The participants in this study were 126 women from 5 government resettlement centers throughout South Korea. Questionnaires which included State-Trait Anxiety Inventory (STAI), Center for Epidemiological studies-Depression Scale (CED-S), and Symptom Checklist-90-Revised (SCL-90-R) were used to identify anxiety and somatization. Data were collected between June and September, 2012. RESULTS: The women reported the following problems; amenorrhea (9.5%), hypomenorrhea (13.6%), menorrhagia (19.8%), polymenorrhea (13.5%), oligomenorrhea (4.8%), changes in amount of menstrual discharge (4.0%), and changes in amount of blood clot (9.5%). Anxiety (r=0.20, p=0.002), depression (r=0.25, p=0.005), and Somatization (r=0.35, p<0.001) were correlated with number of menstrual problems. CONCLUSION: The results of this study indicate that mental health services need to be taken into account in interventions for North Korean woman defectors to improve their reproductive health including addressing menstrual problems.

A Systematic Review of Birth Experience Assessment Instrument

PURPOSE: This study aimed to conduct a systematic review and to describe characteristics of the birth experience assessment instrument. METHODS: Literature related to the development of the birth experience assessment instrument was examined using a systematic review method. A literature search was conducted using the keywords as ‘[normal birth]; [satisfac* OR care quality]; [instrument OR scale] AND (development)’ through PubMed, CINAHL, SCOPUS, PsycINFO, and RISS. The search used quality appraisal through QUADAS (Quality Assessment of studies of Diagnostic Accuracy included Systemic reviews) yielding 17 records. RESULTS: The birth experience assessment instrument was categorized for instrumental characteristics: birth satisfaction (n=8), perception of labor experience (n=5), and birth care quality assessment in normal and operative birth experiences (n=4). Important key elements for content characteristics were as follows: nursing practice (n=10), pain control (n=5), environment (n=5), participation (n=4), and support (n=4). CONCLUSION: This study demonstrated that the birth experience instrument is appropriate for measuring quality of birth care in various clinical conditions. This review of the birth experience instrument reports that an appropriate psychometric tool for enhancing quality of birth care is important.

Difference in Maternal Weight Gain and Pregnancy Outcomes According to Pregnancy at an Advanced Maternal Age at a Single Women's Hospital in South Korea

PURPOSE: This study aimed to investigate the differences of pregnancy outcomes according to advanced-age pregnancy among Korean women in South Korea. METHODS: This study used nursing records of 242 women who gave birth at a single women's hospital in South Korea. Data consisted of maternal obstetric history, maternal body weight, gestational age, birth types, newborn's Apgar scores, and newborn's physical measures. Data were collected between June and December of 2015. Data were analyzed using mean, percentage, t-test, chi test, Fisher's exact test, and repeated general linear model. RESULTS: The differences of obstetric characteristics according to pregnancy at maternal age over 35 years were not significant. Maternal body weight was affected not by pregnancy at advanced maternal age (F=0.10, p=0.182) but by weight before pregnancy (F=35.56, p<0.001). Pregnancy outcome concerning newborn's Apgar scores and physical measure did not differ between mothers who were at an advanced age and those who were not. Planned pregnancies were more common at maternal age ≥35 than at age <35. Natural childbirth and cesarean section in mothers at maternal age ≥35 was lower than at age <35. CONCLUSION: This study demonstrates that maternal weight and pregnancy outcomes of newborns were not different according to pregnancy at advanced maternal age. Type of birth was more risky than natural in advanced age. Therefore, health care provider should pay attention to the planning process, pregnancy, and birth in women with advanced maternal age.

Effects of Home-Based Intervention Program to Prevent Child Abuse for Parents: A Meta Analysis

PURPOSE: This study was done to conduct a meta-analysis of articles describing randomized controlled trials which showed substantiated effects for home-based child abuse prevention programs for all parents. METHODS: The articles regarding child abuse prevention programs for parents were investigated using the systematic review method. A literature search was conducted in PubMed, CINAHL, PsycINFO, Cochrane central library, Eric, and RISS on material published. Article searches and quality appraisal through RoB (Risk of Bias) yielded 14 records. RESULTS: The total random effect size was 0.344 (Parents outcome, 0.333; Child outcome, 0.310; Environment, 0.275). The home based intervention for parents was effective for prevention of potential child abuse. CONCLUSION: This study supports the effectiveness of health care professional directing child abuse prevention programs for all parents whose children are in the early years of life including during the period of pregnancy.

Difference of Traumatic Experience according to Menstrual Regularity among North Korean Woman Refugees in South Korea

PURPOSE: This study aimed to investigate the differences of traumatic experience according to menstrual regularity among North Korean woman refugees in South Korea. METHODS: This study used a sample of convenience consisting of 131 women in 5 government resettlement centers throughout South Korea. The traumatic experiences scale for North Korean defectors was used for identifying traumatic experience. Data were collected between June 2012 and December 2012. Data was analyzed using mean, percentage, and t-test. RESULTS: The rate of irregular menstruation was 35.1%. Irregular menstruation group had more traumatic experiences than regular one (t=-1.78, p=.038). CONCLUSION: This study demonstrates that their reproductive health promotion was necessary regarding menstrual problem. Also, their severe traumatic experiences were considered into healthcare program.

A Concept Analysis of Cultural Nursing Competence

PURPOSE: The aim of this study was to conduct a concept analysis of cultural nursing competence. METHODS: Cultural nursing competence was analyzed using Rodgers' evolutionary concept development method. A literature search using the keywords "cultural nursing competence", "intercultural nursing competence", "cultural nursing", "cultural health nursing", and "cultural competence" was conducted in PubMed, CINAHL, ERIC, and RISS on material published before 2015. Database and bibliographic searches yielded 35 records. RESULTS: Cultural nursing competence comprised cognitive, affective, and behavioral domains. The critical attributes of the concept were sensitivity, equality, and activity. The analysis identified the following dimensions: awareness, openness, and coherence. The consequences of cultural nursing competence were personal satisfaction and social justice. The definition contained competence on both an individual and social level. CONCLUSION: Cultural competency enhances quality of care by narrowing health disparities and increasing client satisfaction. The concept analysis of cultural nursing competence may offer an acceptable framework which can be used to develop psychometric tools of this concept and provide guidelines in nursing practice.

Course-embedded assessment in Korean nursing baccalaureate education / 한국의학교육

PURPOSE: This study aimed to evaluate the program outcome in nursing baccalaureate in Korea. The analysis based on course embedded assessment. The concrete objectives were establishment of program outcome assessment, confirmation of student competency through weighting of program outcomes, and using the results of the evaluation in the circular feedback process in a nursing school in Korea. METHODS: This study was conducted with a nursing education curriculum in a Korean nursing school. Data were collected through 28 students’ program outcome measurement from January 2013 to December 2014. Data were analyzed using a pairwise comparison method and analytic hierarchy process. RESULTS: There were 1 to 3 direct and indirect assessment tools and for each program outcomes and each tool had measurable rubrics. There were 1 to 3 direct assessment tools for each program outcome, and each tool had measurable rubrics. This model derived rank of program outcomes from "care integration" to "global perception" through weight calculation. All direct assessment results were over 70%. The indirect assessment results were over the cutoff except for program outcomes 4 and 7. CONCLUSION: Each step of course embedded assessment was adaptive in nursing program outcome measure. The achievement of learning outcome provided reasonable tools for faculty and students.