Prevalence and Risk Factors of Diabetic Retinopathy in Diabetes People using Korean National Health and Nutrition Examination Survey VII

Purpose@#This study aimed to investigate the prevalence and risk factors of diabetic retinopathy (DR) in people with diabetes mellitus (DM) using Korean National Health and Nutrition Examination Survey VII (2017~2018). @*Methods@#DM was defined as in two ways; 1) doctor's diagnosis (Group 1, n=549), 2) one of doctor's diagnosis, medication, or hyperglycemia (Group 2, n=849). The DR prevalence was measured as the prevalence proportion (%). Risk factors for developing DR were analyzed using multiple logistic regression, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. @*Results@#The prevalence of DR was 25.87% in Group 1 and 20.14% in Group 2. Risk factors for DR were identified as insulin therapy (Group 1: OR=5.31, Group 2: OR=5.27), DM duration ≥10 years (Group 1: OR=2.20, Group 2: OR=3.10), and systolic blood pressure ≥140 mmHg (Group 1: OR=2.26, Group 2: OR=2.23) for both groups. @*Conclusion@#Considering the DR prevalence, eye examinations education is highly recommended as part of a diabetes management programs in the community. It is also proposed to shorten the eye examination cycle for people with risk factors and establish a referral system to link between screening to treatment.

Epidemiological characteristics of carbapenemresistant Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii in a tertiary referral hospital in Korea

Objectives@#This study aimed to identify the epidemiological characteristics of patients with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii (CRE/CRAB) isolates in a tertiary referral hospital in Korea. @*Methods@#We collected and analyzed data from 528 adults admitted to a tertiary referral hospital from August 1, 2018 to February 29, 2020. The CRE/CRAB isolates were confirmed as being present at the time of patients’ admission or acquired during hospitalization based on their medical records. The t-test, chi-square test, or Fisher exact test and stepwise multiple logistic regression were performed. @*Results@#While the proportion of community-acquired CRE/CRAB was low (6%), 20% of CRE/CRAB isolates were identified in patients at the time of hospitalization. The risk of CRAB isolation was positively associated with mechanical ventilator use (odds ratio [OR], 3.52; 95% confidence interval [CI], 1.96−6.33) and total parenteral nutrition use (OR, 3.64; 95% CI, 1.87−7.08). @*Conclusion@#Over 20% of CRE/CRAB isolates in a tertiary referral hospital in Korea were found at the time of patients’ admission. Furthermore, patients with mechanical ventilation and/or total parenteral nutrition tended to acquire CRAB more frequently. Thus, active surveillance for CRE/CRAB at the time of hospitalization is strongly required, particularly for patients who are expected to require mechanical ventilation or total parenteral nutrition.

Incidence and Predictors of Cataract among People with Type 2 Diabetes Mellitus: Using Secondary Data Analysis from the Ansan Cohort of the Korean Genome and Epidemiology Study

Purpose@#This study investigated the incidence and risk factors of cataract in people with diabetes mellitus (DM) using data from Ansan cohort of the Korean Genome and Epidemiology Study (KoGES). @*Methods@#Data from a total of 329 patients with type 2 DM without cataract who participated in Ansan cohort of the KoGES from baseline survey (2001–2002) to fifth follow-up visit (2011–2012) were examined.The characteristics of the subjects were analyzed with frequency and percentage, and mean and standard deviation. Cataract incidence was measured as incidence proportion (%). For risk factors of cataract, hazard ratio (HR) and 95% confidence interval (CI) were obtained using the Cox proportional hazard model. @*Results@#The cataract incidence over a 10-year follow-up period was 19.1% (15.1 in males and 25.8 in females), and mean age at the incidence of cataract was 63.48 years (61.58 years in males and 65.31 years in females). Age (HR=1.09, 95% CI=1.05–1.13) and HbA1c (HR=1.21, 95% CI=1.07–1.37) or the duration of DM (HR=1.05, 95% CI=1.00–1.09) were found to be independently associated with cataract development. @*Conclusion@#Cataract development in people with DM is common, and its likelihood increases with age, HbA1c, and the duration of DM. Considering negative effect of cataract on their quality of life and economic burden, nurses should identify people with DM at a higher risk of cataract development, and plan individual eye examination programs to detect cataract development as early as possible.

Incidence and Risk Factors of Dyslipidemia after Menopause

Purpose@#This study was aimed at investigating the incidence and risk factors of dyslipidemia in menopausal women using a Korean community-based longitudinal study. @*Methods@#The subjects were 245 postmenopausal women without dyslipidemia who had participated in the Ansan-Ansung cohort study from 2001~2002 (baseline) to 2015~2016 (seventh follow-up visit). The dyslipidemia incidence was measured as incidence proportion (%) and incidence rate per 100 person-years. The predictors of developing dyslipidemia were analyzed with Cox’s proportional hazard model. @*Results@#The incidence of new dyslipidemia during the follow-up period was 78.4% (192 patients), and 11.9 per 100 person-years. Mean duration from menopause to developing dyslipidemia was 5.3 years in new dyslipidemia cases. The triglyceride/high density lipoprotein (TG/HDL-C) ratio at baseline (hazard ratio = 2.20; 95% confidence interval = 1.39~3.48) was independently associated with developing dyslipidemia. @*Conclusion@#Dyslipidemia occurs frequently in postmenopausal women, principally within five years after menopause. Therefore, steps must be taken to prevent dyslipidemia immediately after menopause, particularly in women with a high TG/HDL-C ratio at the start of menopause.

Compliance with Recommendations on Work Schedule for Shift Nurses in South Korea

Background@#A well-designed shift schedule has been reported to have a positive effect on improving health problems associated with shift work. This study aimed to identify compliance with the 17 recommendations on work schedule (WSRs) for shift nurses and related factors. @*Methods@#The descriptive study was conducted with 182 nurses who worked in three shifts for more than 1 year at superior general and general hospitals in three regions. Data were collected with self-administered questionnaire and 13-week work schedule tables, and analyzed with both person- and cycle-based compliance. @*Results@#Person-based compliance was 11.77 among 17 items in total. However, no one completely complied with WSRs of “no work on weekends” and which showed the lowest cycle-based compliance (22.3%). Compliance with some WSRs was related to hospital type, proportion of nurses in school and having standards on work schedule at institutional level. @*Conclusion@#Compliance with WSRs of shift nurses in Korea is still unsatisfactory, and one day off after night shift and work on weekend are quite common. Hospitals should keep the standards on work schedule, monitor compliance with standards, and try to introduce modified shift systems to improve the current problems.

Sex differences in the relationship between depression and cardiovascular disease risk: a nationwide study in Korea

Objectives@#This study aimed to identify sex differences in the association between depression and the risk of developing cardiovascular disease (CVD). @*Methods@#A secondary analysis was conducted of data from the fifth to seventh waves (2010−2018) of the Korea National Health and Nutrition Examination Survey. The participants were adults aged 30−74 years who had no diagnosis of CVD. The CVD risk was calculated using the Framingham Risk Score algorithm. Multiple linear regression analysis was conducted to identify the association between depression and CVD risk using a complex sample design. @*Results@#The mean CVD risk was higher in males and females with current depression(14.72% vs. 6.35%, respectively) than in males without current depression (11.67% and 4.42%, respectively). Current depression showed a significant association with CVD risk after controlling for only health-related characteristics, but the significance disappeared in both males and females when demographic characteristics were additionally controlled. @*Conclusion@#The presence of depression was not associated with CVD risk regardless of sexafter controlling for confounding factors. Further studies are recommended to investigate the relationship between depression and CVD risk in a larger sample of both males and females with depression.

Development of a Diabetic Foot Ulceration Prediction Model and Nomogram

Purpose@#This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). @*Methods@#This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients’ electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow–Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. @*Results@#The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ2 = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. @*Conclusion@#The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.

Level of Complete Knowledge on Five Moments of Hand Hygiene among Nurses Working at Integrated Nursing Care Service Wards

Purpose@#This study aimed to identify the level of complete knowledge about hand hygiene indications among nurses working at integrated nursing care service wards. @*Methods@#A total of 127 nurses in eight integrated nursing care service wards completed structured sheets while observing a video based on six scenarios developed by the research team. Complete knowledge level was calculated as the percentage (%) of participants who responded correctly to all questions among participants. Complete knowledge levels according to the scenarios were calculated and compared according to general characteristics using the chi-squared test or Wilcoxon rank-sum test. @*Results@#The complete knowledge level for each scenario ranged from 7.9% (scenario 6) to 42.5% (scenarios 4 and 5), and no one had complete knowledge of all scenarios. Only 3.1% of participants demonstrated complete knowledge in more than four scenarios, and 26.0% had complete knowledge of four or more hand hygiene moments. Complete knowledge level per scenario did not differ depending on work experience at hospitals and study wards, or prior hand hygiene training in the last year. @*Conclusion@#As the complete knowledge level regarding hand hygiene moment is very low, it is suggested that regular hand hygiene training should be provided to nurses using video media that reflect real nursing tasks. Thus, they can acquire complete knowledge of when hand hygiene is needed or not during complex nursing work situations.

Impact of Obesity on Urinary Tract Infections in Korean Adults:Secondary Data Analysis Using Community-Based Cohort Study

Purpose@#This study investigated the incidence of urinary tract infection (UTI) in community-dwelling adults and identified the association between obesity and UTI. @*Methods@#The participants were 4,926 adults aged over 40 years who had no UTIs at the baseline survey of the Korean Genome Epidemiology Study. Obesity was defined according to the cirtieria of Korean Society for the Study of Obesity using body mass index (BMI) data. UTI was defined as those who had self-reported UTI or had either nitrite, or both leukocytes and blood in the urine dipstick test. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using a multivariate Cox proportional hazards regression analysis to identify the association between the obesity and UTI. @*Results@#The incidence proportion of UTI was 5.1%, and the incidence density per 1,000 person-years was 25.5. After controlling general characteristics, people with BMI ≥30.0 kg/m2 remained 1.66 times (HR = 1.66, 95% CI = 1.06~2.60; p < .05) more likely to have UTI than those with normal weight. This trend was also present in men or people aged ≥ 60 years. Among women aged ≥ 60 years, people with BMI ≥ 30.0 kg/m2 were 1.98 times (HR = 1.98, 95% CI = 1.01~3.86; p < .05) more likely to have UTI than those with normal weight. @*Conclusion@#The BMI ≥ 30.0 kg/m2 is a risk factor of UTIs in Korean adult men over 40 years and women aged ≥ 60 years. It is necessary to emphasize the importance of obesity management to men or women aged ≥ 60 years, specifically.

Personal Listening Device Use Habits, Listening Belief, and Perceived Change in Hearing Among Adolescents

Purpose@#This study aimed to identify personal listening device (PLD) usage habits, listening belief, and perceived change in hearing, and to investigate how the variables related to perceived change in hearing among adolescents. @*Methods@#The participants were 183 middle school students and 233 high school students from Ulsan. Data were collected by self-reported questionnaires from August 1, 2019, to October 22, 2019, and analyzed with descriptive statistics, χ2 test, Mann–Whitney U test, and hierarchical multiple logistic regression. @*Results@#Most students started to use PLDs from elementary school, and mean preferred listening level was 70.13 dB. Mean perceived susceptibility to music-induced hearing loss (MIHL) and perceived barriers to prevent MIHL were 5.18 and 3.40, respectively. Perceived change in hearing was reported on 14.2% of middle school students and 32.2% of high school students, and as the average score of perceived barriers to prevent MIHL increases by one point, the odds of decrease in hearing increase by 2.05 times (p < .001) and 1.35 times (p < .05), respectively. @*Conclusion@#Considering that most adolescents are exposed to PLD in elementary schools and about a quarter experienced a decrease in hearing after PLD use, educational programs on hearing conservation are required to start as early as in schools. Particularly, knowledge and skills to overcome barriers to prevent MIHL should be emphasized in educational programs.

Level of and Related Factors to Diabetes Awareness among Diabetic Adults by Gender: Based on Data from the Korean National Health and Nutrition Examination Survey

Purpose@#This study aimed to determine the level of awareness about diabetes mellitus (DM) and identify the associated factors among diabetic adults in Korea by sex, using data from most recent nationwide representative survey. @*Methods@#Secondary data analysis was conducted using data obtained from the Korean National Health and Nutrition Examination Survey VII (2016–2018). In total, 2,026 participants (1,049 men, 977 women) aged ≥30 years with DM were included. Data were analyzed using a complex sample analysis considering the combined sampling weight for 3 years. Odds ratios and 95% confidence intervals were calculated using stepwise multiple logistic regression analysis to identify the association between DM awareness (DA) and sociodemographic and health-related factors. @*Results@#Researchers observed that 60.2% of men and 68.4% of women had DA. DA levels in both men and women were higher in those who were older, less educated, had normal weight, had hypertension and/or dyslipidemia, and had a family history of DM than in their counterparts. Having undergone a health screening in the past 2 years was associated with DA levels in men, whereas glycated hemoglobin levels of 5.7–6.4% were associated with higher DA levels in women. @*Conclusion@#The level of DA is unsatisfactory. Although the DA level is slightly higher in women than in men, it needs to be improved regardless of gender. Most of the factors associated with DA levels are similar in both men and women. Nurses in the community setting should provide health education, conduct campaigns, and promote referral to medical services by targeting the high-risk groups with lower DA identified in this study.

Development of a Nomogram for Carbapenem-Resistant Enterobacteriaceae Acquisition Risk Prediction Among Patients in the Intensive Care Unit of a Secondary Referral Hospital

Purpose@#This study aimed to identify the risk factors of carbapenem-resistant Enterobacteriaceae (CRE) acquisition to build a nomogram for CRE acquisition risk prediction and evaluate its performance. @*Methods@#This unmatched case-control study included 352 adult patients (55 patients and 297 controls) admitted to the intensive care unit (ICU) of a 453-bed secondary referral hospital between January 1, 2018, and September 31, 2019, in Busan, South Korea. The nomogram was built with the identified risk factors using multiple logistic regression analysis. Its performance was analyzed using calibration-in-the-large, the slope of the calibration plot, concordance statistic (c-statistic), and the sensitivity and specificity of the training set, subsets, and a new test set. @*Results@#The risk factors of CRE acquisition among ICU patients at a secondary referral hospital were Acute Physiology and Chronic Health Evaluation II score at the time of admission, use of a central venous catheter and a nasogastric tube, as well as use of cephalosporin antibiotics. At 20.0% of the predicted CRE acquisition risk in the training set, the calibration-in-the-large was 0, slope of the calibration plot was 1, c-statistic was .93, sensitivity was 85.5%, and specificity was 84.8%. The performance was relatively good in the subsets and new test set. @*Conclusion@#The nomogram can be used to monitor the CRE acquisition risk for ICU patients who have a similar case mix to patients in the study hospitals. Future studies need to involve more rigorous methodology and larger samples.

Compliance with Recommendations on Work Schedule for Shift Nurses in South Korea

Background@#A well-designed shift schedule has been reported to have a positive effect on improving health problems associated with shift work. This study aimed to identify compliance with the 17 recommendations on work schedule (WSRs) for shift nurses and related factors. @*Methods@#The descriptive study was conducted with 182 nurses who worked in three shifts for more than 1 year at superior general and general hospitals in three regions. Data were collected with self-administered questionnaire and 13-week work schedule tables, and analyzed with both person- and cycle-based compliance. @*Results@#Person-based compliance was 11.77 among 17 items in total. However, no one completely complied with WSRs of “no work on weekends” and which showed the lowest cycle-based compliance (22.3%). Compliance with some WSRs was related to hospital type, proportion of nurses in school and having standards on work schedule at institutional level. @*Conclusion@#Compliance with WSRs of shift nurses in Korea is still unsatisfactory, and one day off after night shift and work on weekend are quite common. Hospitals should keep the standards on work schedule, monitor compliance with standards, and try to introduce modified shift systems to improve the current problems.

Sex differences in the relationship between depression and cardiovascular disease risk: a nationwide study in Korea

Objectives@#This study aimed to identify sex differences in the association between depression and the risk of developing cardiovascular disease (CVD). @*Methods@#A secondary analysis was conducted of data from the fifth to seventh waves (2010−2018) of the Korea National Health and Nutrition Examination Survey. The participants were adults aged 30−74 years who had no diagnosis of CVD. The CVD risk was calculated using the Framingham Risk Score algorithm. Multiple linear regression analysis was conducted to identify the association between depression and CVD risk using a complex sample design. @*Results@#The mean CVD risk was higher in males and females with current depression(14.72% vs. 6.35%, respectively) than in males without current depression (11.67% and 4.42%, respectively). Current depression showed a significant association with CVD risk after controlling for only health-related characteristics, but the significance disappeared in both males and females when demographic characteristics were additionally controlled. @*Conclusion@#The presence of depression was not associated with CVD risk regardless of sexafter controlling for confounding factors. Further studies are recommended to investigate the relationship between depression and CVD risk in a larger sample of both males and females with depression.

Development of a Diabetic Foot Ulceration Prediction Model and Nomogram

Purpose@#This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). @*Methods@#This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients’ electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow–Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. @*Results@#The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ2 = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. @*Conclusion@#The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.

Level of Complete Knowledge on Five Moments of Hand Hygiene among Nurses Working at Integrated Nursing Care Service Wards

Purpose@#This study aimed to identify the level of complete knowledge about hand hygiene indications among nurses working at integrated nursing care service wards. @*Methods@#A total of 127 nurses in eight integrated nursing care service wards completed structured sheets while observing a video based on six scenarios developed by the research team. Complete knowledge level was calculated as the percentage (%) of participants who responded correctly to all questions among participants. Complete knowledge levels according to the scenarios were calculated and compared according to general characteristics using the chi-squared test or Wilcoxon rank-sum test. @*Results@#The complete knowledge level for each scenario ranged from 7.9% (scenario 6) to 42.5% (scenarios 4 and 5), and no one had complete knowledge of all scenarios. Only 3.1% of participants demonstrated complete knowledge in more than four scenarios, and 26.0% had complete knowledge of four or more hand hygiene moments. Complete knowledge level per scenario did not differ depending on work experience at hospitals and study wards, or prior hand hygiene training in the last year. @*Conclusion@#As the complete knowledge level regarding hand hygiene moment is very low, it is suggested that regular hand hygiene training should be provided to nurses using video media that reflect real nursing tasks. Thus, they can acquire complete knowledge of when hand hygiene is needed or not during complex nursing work situations.

Impact of Obesity on Urinary Tract Infections in Korean Adults:Secondary Data Analysis Using Community-Based Cohort Study

Purpose@#This study investigated the incidence of urinary tract infection (UTI) in community-dwelling adults and identified the association between obesity and UTI. @*Methods@#The participants were 4,926 adults aged over 40 years who had no UTIs at the baseline survey of the Korean Genome Epidemiology Study. Obesity was defined according to the cirtieria of Korean Society for the Study of Obesity using body mass index (BMI) data. UTI was defined as those who had self-reported UTI or had either nitrite, or both leukocytes and blood in the urine dipstick test. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using a multivariate Cox proportional hazards regression analysis to identify the association between the obesity and UTI. @*Results@#The incidence proportion of UTI was 5.1%, and the incidence density per 1,000 person-years was 25.5. After controlling general characteristics, people with BMI ≥30.0 kg/m2 remained 1.66 times (HR = 1.66, 95% CI = 1.06~2.60; p < .05) more likely to have UTI than those with normal weight. This trend was also present in men or people aged ≥ 60 years. Among women aged ≥ 60 years, people with BMI ≥ 30.0 kg/m2 were 1.98 times (HR = 1.98, 95% CI = 1.01~3.86; p < .05) more likely to have UTI than those with normal weight. @*Conclusion@#The BMI ≥ 30.0 kg/m2 is a risk factor of UTIs in Korean adult men over 40 years and women aged ≥ 60 years. It is necessary to emphasize the importance of obesity management to men or women aged ≥ 60 years, specifically.

Personal Listening Device Use Habits, Listening Belief, and Perceived Change in Hearing Among Adolescents

Purpose@#This study aimed to identify personal listening device (PLD) usage habits, listening belief, and perceived change in hearing, and to investigate how the variables related to perceived change in hearing among adolescents. @*Methods@#The participants were 183 middle school students and 233 high school students from Ulsan. Data were collected by self-reported questionnaires from August 1, 2019, to October 22, 2019, and analyzed with descriptive statistics, χ2 test, Mann–Whitney U test, and hierarchical multiple logistic regression. @*Results@#Most students started to use PLDs from elementary school, and mean preferred listening level was 70.13 dB. Mean perceived susceptibility to music-induced hearing loss (MIHL) and perceived barriers to prevent MIHL were 5.18 and 3.40, respectively. Perceived change in hearing was reported on 14.2% of middle school students and 32.2% of high school students, and as the average score of perceived barriers to prevent MIHL increases by one point, the odds of decrease in hearing increase by 2.05 times (p < .001) and 1.35 times (p < .05), respectively. @*Conclusion@#Considering that most adolescents are exposed to PLD in elementary schools and about a quarter experienced a decrease in hearing after PLD use, educational programs on hearing conservation are required to start as early as in schools. Particularly, knowledge and skills to overcome barriers to prevent MIHL should be emphasized in educational programs.

Level of and Related Factors to Diabetes Awareness among Diabetic Adults by Gender: Based on Data from the Korean National Health and Nutrition Examination Survey

Purpose@#This study aimed to determine the level of awareness about diabetes mellitus (DM) and identify the associated factors among diabetic adults in Korea by sex, using data from most recent nationwide representative survey. @*Methods@#Secondary data analysis was conducted using data obtained from the Korean National Health and Nutrition Examination Survey VII (2016–2018). In total, 2,026 participants (1,049 men, 977 women) aged ≥30 years with DM were included. Data were analyzed using a complex sample analysis considering the combined sampling weight for 3 years. Odds ratios and 95% confidence intervals were calculated using stepwise multiple logistic regression analysis to identify the association between DM awareness (DA) and sociodemographic and health-related factors. @*Results@#Researchers observed that 60.2% of men and 68.4% of women had DA. DA levels in both men and women were higher in those who were older, less educated, had normal weight, had hypertension and/or dyslipidemia, and had a family history of DM than in their counterparts. Having undergone a health screening in the past 2 years was associated with DA levels in men, whereas glycated hemoglobin levels of 5.7–6.4% were associated with higher DA levels in women. @*Conclusion@#The level of DA is unsatisfactory. Although the DA level is slightly higher in women than in men, it needs to be improved regardless of gender. Most of the factors associated with DA levels are similar in both men and women. Nurses in the community setting should provide health education, conduct campaigns, and promote referral to medical services by targeting the high-risk groups with lower DA identified in this study.

Development of a Nomogram for Carbapenem-Resistant Enterobacteriaceae Acquisition Risk Prediction Among Patients in the Intensive Care Unit of a Secondary Referral Hospital

Purpose@#This study aimed to identify the risk factors of carbapenem-resistant Enterobacteriaceae (CRE) acquisition to build a nomogram for CRE acquisition risk prediction and evaluate its performance. @*Methods@#This unmatched case-control study included 352 adult patients (55 patients and 297 controls) admitted to the intensive care unit (ICU) of a 453-bed secondary referral hospital between January 1, 2018, and September 31, 2019, in Busan, South Korea. The nomogram was built with the identified risk factors using multiple logistic regression analysis. Its performance was analyzed using calibration-in-the-large, the slope of the calibration plot, concordance statistic (c-statistic), and the sensitivity and specificity of the training set, subsets, and a new test set. @*Results@#The risk factors of CRE acquisition among ICU patients at a secondary referral hospital were Acute Physiology and Chronic Health Evaluation II score at the time of admission, use of a central venous catheter and a nasogastric tube, as well as use of cephalosporin antibiotics. At 20.0% of the predicted CRE acquisition risk in the training set, the calibration-in-the-large was 0, slope of the calibration plot was 1, c-statistic was .93, sensitivity was 85.5%, and specificity was 84.8%. The performance was relatively good in the subsets and new test set. @*Conclusion@#The nomogram can be used to monitor the CRE acquisition risk for ICU patients who have a similar case mix to patients in the study hospitals. Future studies need to involve more rigorous methodology and larger samples.