Impact of Age on Clinical Outcomes in Middle-aged Korean Female Patients with Acute Myocardial Infarction - Based on a Cut-off Age of 55 Years / 대한내과학회지

BACKGROUND/AIMS: It is well known that the menopause is related to interference in lipid metabolism, obesity, and a hypercoagulable state. The aim of the present study was to examine the impact of the menopause in middle-aged Korean females with acute myocardial infarction (AMI). METHODS: A total of 1,781 middle-aged females (aged < 65 years) in the Korean Acute Myocardial Infarction registry were enrolled into this study between November 2005 and December 2013. The patients were divided into two groups; the pre-menopause group (≤ 55 years old) and the menopause group (56-64 years old). Major adverse cardiac events (MACE) were analyzed over a one-year follow-up period. RESULTS: The pre-menopause and menopause groups comprised 669 patients (mean age, 49.1 ± 5.6 years) and 1,112 patients (mean age, 60.6 ± 2.6 years), respectively. The incidence of hypertension (42.2% vs. 59.4%, p < 0.001), diabetes mellitus (DM) (27.4% vs. 35.7%, p < 0.001), and dyslipidemia (12.9% vs. 17.7%, p = 0.008) were more frequent in menopausal patients. Additionally, the rates of smoking (20% vs. 12.7%, p < 0.001) and familial history (12% vs. 6.8%, p < 0.001) were higher in the pre-menopause group. The cumulative rates of MACE did not show any differences between the two groups. A history of atrial fibrillation, previous AMI and DM, higher Killip class, and multi-vessel disease were independent risk factors for predicting one-year MACE. CONCLUSIONS: The survival analysis demonstrated that there was no significant difference in MACE rates between the pre-menopause and menopause groups during the one-year follow-up. Therefore, middle-aged pre-menopausal women should be treated more intensively, regardless of whether they are menopausal.

Affecting Factors on Stress of Clinical Practice in Nursing Students / 간호행정학회지

PURPOSE: This descriptive study was done to identify factors that influence stress related to clinical practice for nursing students. METHODS: Structured questionnaires were used to collect data from 278 students from two nursing colleges located in G metropolitan city and one nursing college in C region. RESULTS: The factors that most influenced stress for the nursing students during their clinical practice were critical thinking disposition, clinical competence, year, and gender. Especially, the result showed that higher critical thinking disposition and clinical competence correlated with lower stress in clinical practice. CONCLUSION: The results indicate that improving nursing students' critical thinking ability and clinical competence would help to relieve stress during clinical practice and increase the ability to cope with stress efficiently. The development of a variety of teaching and learning strategies and education in both theoretical and clinical practice education would be necessary to achieve this goal.

A New Risk Score to Predict 1-Year Mortality in Acute Non-ST Elevation Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: Accurate risk stratification is important in the management of patients with acute myocardial infarction (AMI). This study aimed to develop a new assessment tool for the prediction of 1-year mortality in patients with AMI, including biochemical markers. The author developed a new assessment tool (new risk score) that takes biochemical markers into account for 1-year mortality in patients with non-ST elevation myocardial infarction (NSTEMI) and identifies the risk factors related to 1-year mortality. METHODS: A total of 1,427 patients (65 +/- 11.8 years of age, 985 males) who were admitted to the Chonnam National University Hospital with NSTEMI from November 2005 to March 2012 were retrospectively analyzed for score derivation. Multivariable Cox-regression analysis was used to select correlates of 1-year mortality that were subsequently weighted and integrated into an integer scoring system. RESULTS: Seven variables selected from the initial multivariate model were weighted proportionally to their respective hazard ratio for 1-year mortality; age > or = 65 years (2 points), N-terminal pro-brain natriuretic peptide (NT pro-BNP) > 991 pg/mL (1 point), baseline left ventricular ejection fraction 3 mg/dL (1 point), glomerular filtration rate (GFR) 82 beats/min (2 points), and final thrombolysis In myocardial infarction flow < 3 (2 points). CONCLUSIONS: In NSTEMI patients, our new score that incorporates seven risk factors accurately predicts the 1-year mortality. Additionally, the biochemical markers hs-CRP, NT pro-BNP, and GFR are reliable predictors of 1-year mortality.

Clinical Outcome Comparison of Everolimus- and Biolimus-eluting Stents in Patients with Acute Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: We compared the efficacy and safety of the second-generation everolimus-eluting stent (EES) and the third generation biolimus-eluting stent (BES) in patients with acute myocardial infarction (AMI). METHODS: We analyzed 629 consecutive patients (mean age 65.1 +/- 11.2 years, 426 males) with AMI undergoing percutaneous coronary intervention from February 2008 to April 2012. They were divided into two groups according to stent type (EES group, n = 426; BES group, n = 203). The primary end-point was 2-year major adverse cardiac events (MACEs), defined as the composite of all-cause death, myocardial infarction, target vessel revascularization, non-target vessel revascularization and target lesion revascularization. The secondary end-point was 2-year target lesion failure (TLF). RESULTS: There were no significant differences in baseline characteristics, except that the patients with EES had a significantly higher prevalence of diabetes mellitus (34.7 vs. 22.7%, p = 0.002) and were older (67.1 +/- 11.3 vs. 64 +/- 12.9 years, p = 0.039) compared with the patients with BES. After propensity score matching, 2-year clinical outcomes showed no differences in composite MACEs or TLF between the two groups. Multivariate Cox regression analysis showed that stent type was not a predictor of 2-year mortality or MACEs. However, older age (hazard ratio [HR] 1.037, 95% confidence interval [CI] 1.014-1.060, p = 0.001), diabetes mellitus (HR 2.247, 95% CI 1.426-3.539, p = 0.001) and a left ventricular ejection fraction < or = 45% (HR 3.007, 95% CI 1.978-4.573, p = 0.001) were independent predictors for 2-year MACEs in patients undergoing EES or BES. CONCLUSIONS: Patients with BES had similar clinical 2-year outcomes compared with EES patients with AMI.

Relationship between Neutrophil-to-Lymphocyte Ratio and Plaque Components in Patients with Coronary Artery Disease: Virtual Histology Intravascular Ultrasound Analysis

The aim of this study was to evaluate the relation between neutrophil-to-lymphocyte ratio (NLR) and plaque components assessed by virtual histology-intravascular ultrasound in 399 coronary artery disease (CAD) patients with 471 coronary lesions. We classified the lesions into two groups according to the NLR on admission {low NLR group (NLR2.73 [n=101])}. By volumetric analysis, total atheroma and the absolute necrotic core (NC) volumes were significantly greater in high NLR group (249.9+/-149.7 microL vs. 192.5+/-127.7 microL, P=0.001, and 32.7+/-26.8 microL vs. 22.8+/-19.4 microL, P=0.001, respectively) and thin-cap fibroatheroma (TCFA) was observed more frequently in high NLR group (33% vs. 18%, P=0.001). ST segment elevation myocardial infarction (odds ratio [OR], 2.159; 95% CI, 1.000-4.660, P=0.050) and NLR>2.73 (OR, 1.848; 95% CI, 1.016-3.360, P=0.044) and total atheroma volume (OR, 1.003; 95% CI, 1.001-1.004, P=0.004) were the independent predictors of TCFA. CAD patients with high NLR had more vulnerable plaque components (greater NC-containing plaques) than those with low NLR.

Factors Influencing Delay in Symptom-to-Door Time in Patients with Acute ST-Segment Elevation Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: Delay in symptom-to-door time (SDT) in patients with acute ST-segment elevation myocardial infarction (STEMI) is the most important factor in the prediction of short and long-term mortality. The purpose of this study was to investigate the social and clinical factors affecting SDT in patients with STEMI. METHODS: We analyzed 784 patients (61.0 +/- 13.2 years, 603 male) diagnosed with STEMI from November 2005 to February 2012. The patients were divided into four groups according to SDT: Group I (n = 163, 3 h). RESULTS: Delay in SDT increased with age (Group I, 58.4 +/- 12.0; Group II, 59.4 +/- 13.3; Group III, 62.0 +/- 12.8; Group IV, 63.0 +/- 13.8 years, p = 0.001). In 119 patients, transportation was less frequently used as the delay in SDT (41.7% vs. 29.0% vs. 26.1% vs. 9.8%, p < 0.001). By multiple logistic regression analysis, family history [OR, 0.488; CI, 0.248-0.959; p = 0.037], previous ischemic heart disease [OR, 0.572; CI, 0.331-0.989; p = 0.045], no occupation [OR, 1.600; CI, 1.076-2.380; p = 0.020] and method of transportation [OR, 0.353; CI, 0.239-0.520; p < 0.001] were independent predictors of delay in SDT. CONCLUSIONS: Our study shows that general education about cardiovascular symptoms and a prompt emergency call could be important to reduce SDT in STEMI.

The Association of Socioeconomic Status with Three-Year Clinical Outcomes in Patients with Acute Myocardial Infarction Who Underwent Percutaneous Coronary Intervention

The aim of this study was to evaluate whether the clinical outcomes were associated with socioeconomic status (SES) in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). The author analyzed 2,358 patients (64.9 +/- 12.3 yr old, 71.5% male) hospitalized with AMI between November 2005 and June 2010. SES was measured by the self-reported education (years of schooling), the residential address (social deprivation index), and the national health insurance status (medical aid beneficiaries). Sequential multivariable modeling assessed the relationship of SES factors with 3-yr major adverse cardiovascular events (MACEs) and mortality after the adjustment for demographic and clinical factors. During the 3-yr follow-up, 630 (26.7%) MACEs and 322 (13.7%) all-cause deaths occurred in 2,358 patients. In multivariate Cox proportional hazards regression modeling, the only lower education of SES variables was associated with MACEs (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.04-1.91) and mortality (HR, 1.93; 95% CI, 1.16-3.20) in the patients with AMI who underwent PCI. The study results indicate that the lower education is a significant associated factor to increased poor clinical outcomes in patients with AMI who underwent PCI.

Job Stress, Organizational Commitment, Way of Coping and Turnover Intention among Korean Visiting Nurses / 한국직업건강간호학회지

PURPOSE: The purpose of the study was to identify factors related to turnover intention among Korean visiting nurses. METHODS: The data from 192 of 208 nurses working in southern part of Korea were collected for analysis during in-service education in May 19~20, 2011. Descriptive statistics, chi-square tests, ANOVA, and logistic regression analysis were performed using SPSS 19.0 program. RESULTS: Among the general characteristic factors, young, married, university graduation, lower satisfaction with income and longer work experience as a nurse were associated with higher odds of turnover intention. Organizational commitment was associated with low turnover intention. Way of coping was not statistically significantly associated with turnover intension. CONCLUSION: Stress from the organizational system was found to be the most important variable that explains the turnover intention in this study. Use of sensible communication methods and introduction of effective conflict resolution system is suggested to reduce turnover intention. Further research is recommended to identify the job demands and organizational systems of visiting nurses.

Construction of a Model of Quality of Life in Longevity Region Dwelling Elders

PURPOSE: The purpose of this study was to identify factors in quality of life and to construct a model of quality of life in longevity region dwelling elders. METHODS: Data were collected from January to July, 2010 through direct interviews and a self-reporting questionnaire survey with 171 subjects who were living at the S County (gun). The collected data were analyzed by using the SPSS/WIN 19.0 and AMOS 19.0 programs. RESULTS: Economic status, social support, health behavior and depression were shown to have direct and total effects on quality of life and were statistically significant. Health status had indirect and total effects on quality of life and was statistically significant. And, self-efficacy had direct, indirect and total effects on quality of life and was statistically significant. These variables of the hypothetical model accounted for 41.4% of quality of life. CONCLUSION: In order to improve quality of life in longevity region dwelling elders, it is necessary to provide economic support and social support services in tandem with social welfare. And, we need to apply interventions strengthening self-efficacy, health behavior, and health status, and decreasing depression.

Comparison of Clinical Outcomes between ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Myocardial Infarction in Patients Younger Than 40 Years Who Underwent Percutaneous Coronary Artery Intervention / 대한내과학회지

BACKGROUND/AIMS: The prevalence of coronary artery disease has increased in young adults. We evaluated the differences in clinical characteristics and clinical outcomes in young patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: A total of 164 patients with acute myocardial infarction who underwent percutaneous coronary intervention were divided into two groups: the STEMI group (120 patients; mean age, 35.7 +/- 3.8 years; 118 males) and the NSTEMII group (44 patients; mean age, 35.7 +/- 4.3 years; 43 males). We analyzed clinical and angiographic characteristics and major adverse cardiac events (MACE), including death from any cause, non-fatal myocardial infarction, target lesion revascularization, and coronary artery bypass graft surgery, during a 1-year clinical follow-up of the two groups. RESULTS: During hospitalization, Killip class II acute myocardial infarction (5.8% vs. 15.9%, p = 0.041) was observed more frequently in the NSTEMI group. The levels of troponin-I (66.9 +/- 103.6 vs. 26.6 +/- 38.5 ng/mL, p = 0.014) and N-terminal pro-brain natriuretic peptide (733.0 +/- 1,018.1 vs. 476.2 +/- 374.5 pg/mL, p = 0.012) were significantly higher in the STEMI group. One-year MACE did not differ between the two groups. By multiple logistic regression analysis, bare metal stents (odds ratio, 3.360; 95% confidence interval, 1.105-10.217; p = 0.033) and high lipoprotein (a) levels (odds ratio, 1.047; 95% confidence interval, 1.020-1.075; p = 0.001) were independent predictors of 1-year MACE. CONCLUSIONS: Young patients with STEMI and NSTEMI have similar clinical outcomes. Bare metal stents and high serum lipoprotein (a) levels are independent predictors of MACE during 1-year clinical follow-ups in young patients with acute myocardial infarction.

Relationship between Coronary Artery Calcium Score by Multidetector Computed Tomography and Plaque Components by Virtual Histology Intravascular Ultrasound

The aim of this study was to evaluate the relationship between coronary artery calcium score (CACS) assessed by multidetector computed tomography (MDCT) and plaque components assessed by virtual histology-intravascular ultrasound (VH-IVUS) in 172 coronary artery disease (CAD) patients with 250 coronary lesions. CACS was assessed according to Agatston scoring method by MDCT and patients were divided into four groups: Group I (CACS = 0 [n = 52]); Group II (CACS = 1-100 [n = 99]); Group III (CACS = 101-400 [n = 84]); and Group IV (CACS > 400 [n = 15]). Total atheroma volume was greatest in Group IV (152 +/- 132 microL vs 171 +/- 114 microL vs 195 +/- 149 microL vs 321+/-182 microL, P < 0.001). The absolute dense calcium (DC) and necrotic core (NC) volumes were greatest, and relative DC volume was greatest in Group IV (5.5 +/- 6.6 microL vs 11.0 +/- 10.3 microL vs 15.6 +/- 13.6 microL vs 36.6 +/- 18.2 microL, P < 0.001, and 14.8 +/- 18.2 microL vs 19.5 +/- 18.9 microL vs 22.5 +/- 19.1 microL vs 41.7 +/- 27.9 microL, P < 0.001, and 6.4 +/- 5.3% vs 11.0 +/- 6.2% vs 14.0 +/- 6.5% vs 20.0 +/- 7.8%, P < 0.001, respectively). The absolute plaque and DC and NC volumes and the relative DC volume correlated positively with calcium score. CAD patients with high calcium score have more vulnerable plaque components (greater DC and NC-containing plaques) than those with low calcium score.

Nitroglycerin-Induced Headache is Associated With Mild Coronary Artery Disease in Patients With Chest Pain

BACKGROUND AND OBJECTIVES: We hypothesized that patients with nitroglycerin-induced headache had preserved systemic vasomotion and there might be an increased nitroglycerin-mediated dilation (NMD) response in the brachial artery. The aim of this study is to evaluate whether nitroglycerin (NTG)-induced headache is associated with the level of the NMD and flow-mediated dilation (FMD) or the severity of coronary artery disease (CAD). SUBJECTS AND METHODS: The study included 87 patients (Group I: mean age: 54.8+/-9.5 years, 46 males) with headache and new onset chest pain, and 109 patients (Group II: mean age: 57.4+/-8.9 years, 67 males) without headache and with new onset of chest pain. Patients were excluded from this study if they had a history of chronic headache, long term nitrates use and coronary artery procedures. Coronary angiography was performed within one month after administering nitroglycerin for the usual clinical indications. RESULTS: The clinical characteristics did not differ between the two groups. The NMD was significantly higher in Group I than in Group II (23.0+/-7.5% vs. 18.5+/-8.6%, respectively, p<0.001). The FMD was significantly higher in Group I than in Group II (9.0+/-4.1% vs. 7.5+/-4.3%, respectively, p=0.007). On multiple regression analysis, NTG-induced headache was a predictor of CAD {oddsratio (OR), 0.04, 95% confidence interval (CI), 0.02-0.11: p<0.001, respectively}. CONCLUSION: We have shown that the vasodilator response to NTG and FMD are increased in the patients with NTG-induced headache. More NTGinduced headache developed in the patients with normal coronary arteries or minimal CAD than in the patients with obstructive CAD. This finding might be helpful as additional information for evaluating the patients with chest pain syndrome.

Increased Inflammatory Markers and Endothelial Dysfunction are Associated with Variant Angina

BACKGROUND AND OBJECTIVES: Endothelial dysfunction and increased vascular inflammation may be associated with variant angina (VA). However, their exact roles remain to be clarified. The aim of the presents study is to investigate whether the level of inflammation markers and the flow-mediated dilation (FMD) are related to VA. SUBJECTS AND METHODS: The study included 46 patients (VA group: 53.9+/-12.0 years, 20 males) with positive spasm provocation tests and they were without significant coronary stenosis, and 14 patients (control group: 46.6+/-13.5 years, 7 males) with negative spasm provocation tests and they were without significant coronary stenosis. The clinical characteristics and inflammatory markers, including the high sensitive C-reactive protein (hsCRP) level, the monocyte count and the von Willebrand factor (vWF) level, and the FMD were compared between the two groups. The FMD and inflammatory markers were measured in the morning before performing the ergonovine provocation coronary angiogram. RESULTS: The level of vWF was significantly higher in the VA group than in the control group (166.5+/-41.9% vs. 118.0+/-65.3%, respectively, p=0.029). The FMD was significantly decreased in the VA group compared with the control group (9.2+/-4.3% vs. 12.4+/-4.2%, respectively, p=0.021). Nitrate-mediated dilation did not differ between the two groups. The levels of the monocyte count, hs-CRP and homocysteine were higher in the VA group than in the control group (554.7+/-261.0/mm3 vs. 440.7+/-136.0/mm3, respectively, p=0.039; 0.3+/-0.4 mg/dL vs. 0.1+/-0.1 mg/dL, respectively, p=0.029; 7.54+/-4.0micronmol/L vs. 5.92+/-1.6micronmol/L, respectively, p=0.033). CONCLUSION: The results of this study suggested that increased inflammatory markers and endothelial dysfunction may be associated with variant angina.

The Effects of Taekwon Aerobic Exercise on Obesity Indices and Cardiovascular Risk Factors in Middle-Aged Obese Women

PURPOSE: The purpose of this study was to identify the effects of taekwon aerobic on obesity indices and cardiovascular risk factors in middle-aged obese women. METHOD: Data were collected from 19 middle-aged obese women who participated in taekwon aerobic exercise. This research adopted one-group pretest-posttest design. Taekwon aerobic was applied 3 times in a week for 12 weeks, and the obesity indices and cardiovascular risk factors were checked before and after the program. Body weight, BMI and % body fat for obesity indices were checked, and total cholesterol, triglyceride, HDL-cholesterol and the ratio of total cholesterol/HDL-cholesterol for cardiovascular risk factors were measured. The data was analyzed by paired t-test using SPSS/Win 10.0. RESULTS: There were significant differences in body weight, BMI and % body fat after the taekwon aerobic exercise. There was a significant difference in total cholesterol. However, there were no significant differences in triglyceride, HDL-cholesterol and the ratio of total cholesterol/HDL-cholesterol after the taekwon aerobic exercise. CONCLUSION: This study showed that taekwon aerobic exercise decreased obesity indices and lowered total cholesterol in the cardiovascular risk factors. The results of this study show that taekwon aerobic exercise is effective in enhancing the health of middle-aged obese women.

A Study of Health Concerns, Health Behavior, and Related Factors in Elders in Senior Centers / 기본간호학회지

PURPOSE: This study was conducted to analyze the health concerns, health behavior, and related factors for elders taking part in activities at senior centers. METHOD: A total of 811 elders were selected through conveniently sampling. Data were collected from November 21, 2006 to December 20, 2006. Data analysis included frequency, t-test, ANOVA, Duncan test, and Stepwise Multiple Regression using SPSS Win 15.0. RESULTS: For health concerns statistically significant differences were found for gender, age, family, pockety money, sleeping time, regular health check-ups, and exercise. For health behavior statistically significant differences were found for gender, age, family, pocket money, religion, medical insurance, perceived health status, sleeping time, regular health check-ups, chronic illness, regular breakfast, exercise, and drinking. Perceived health status was identified as a variable influencing the health behavior. CONCLUSION: The results suggest that perceived health status can be considered as factor for significant nursing interventions to help single elders and older elders in senior centers.

Effects of the Prevention Program on Internet Games Addiction in Middle School Students

No abstract available.

A Study of Assessing Educational Needs on Program Planning for AIDS(Acquired Immuno-deficiency Syndrome) Inservice Education for Clinical Nurses / 간호학회지

Nurses are at the forefront of providing hands-on care to patients infected with HIV(Human Immunodeficiency Virus). Therefore, appropriate and sensible infection control precaution should be taken at all times. The purpose of this study is to find out nurse's learning needs about HIV/AIDS ; and nurse's willingness to perform nursing care to HIV/AIDS patients ; and the degree of following universal precautions in nursing care ; and the degree of knowledge of HIV/AIDS to provide information on the guide for the further continuing education. The respondents of this study were 280 nurses in a university hospital in Kwang-Ju city. Data were collected using a self-administered questionnaire and analyzed by using percentages, means, Pearson's correlation, t-test, ANOVA, Duncan's grouping. The findings were as follows ; 1. The mean age of the nurses was 28.9 years, and the mean duration of their clinical experience was 6.8 years. Majority of the nurses(83.9%) had no experience in taking care of the AIDS patients. 2. The contents nurse's need to learn were showed in order such as clinical manifestations, infection control, patient care, and the mode of transmission of HIV/AIDS. 3. Even though the nurses had quite low knowledge about HIV/AIDS(mean score was 12.2 from the total of 26), they are willing to take care of the AIDS patients (mean score was 39.5 from the total of 60), and the degree of following universal precaution was also not so bad (mean score was 40.8 from the total of 50). 4. Nurses who are over 35 years old and had informal education regarding HIV/AIDS better following universal precautions. Nurses who had over 12 years of clinical experiences have more willingness to perform nursing care to the AIDS patients. Nurses who had experiences in taking care of the AIDS patients were more knowledgeable about HIV/AIDS. These findings suggest that some strategies should be develope to increase the willingness to perform the nursing care to the AIDS patients. And also continuing education program should be develope and run for the clinical nurses so that they can provide effective and appropriate nursing care to the AIDS patients.