Effects of a Stim up Mat Walking Exercise Program on Balance, Gait Function and Joint Motion Range of the Frail Elderly

PURPOSE: This study was performed to evaluate effects of a stim-up matt walking exercise program on balance and gait of the frail elderly. METHODS: A total of 37 elderly people recruited from S city were randomly assigned to the experimental group (n=22) and control group (n=15). The stim-up matt walking exercise program was offered twice a week for 8 weeks. Data were analyzed by SPSS 21.0. RESULTS: The dynamic balance ability Timed Up and Go test of the experimental group was significantly faster than that of the control group (t=21.72, p<.001). The static balance ability open-eye standing test (t=44.15, p<.001) and close-eye standing test (t=9.01, p=.005) also showed increase in effects of the experimental group. In the walking ability, gait cycle (t=2.48, p=.018), cadence (t=−2.21, p=.034) and gait speed (t=−2.78, p=.009), positive effects were on. However, no statistically significant differences were found in stride length and double support. At the ankle joint range left ankle plantar flexion (t=3.92, p<.001) and left ankle dorsal flexion (t=4.51, p<.001) were higher in the experimental group than in the control group, and also right ankle plantar flexion (t=2.79, p=.008) and right ankle dorsal flexion (t=2.92, p=.006) increased in the experimental group. CONCLUSION: The significance of this study is that the stim-up matt walking exercise program for the frail elderly proves to be useful for improving balance and walking.

Factors Affecting the Intention to Participate in Healthcare Programs among Elders Living Alone

PURPOSE: The aim of this study is to identify factors affecting elders' intention to participate in healthcare programs. METHODS: This secondary data analysis used data of 390 elderly people who lived alone and were enrolled in the Visiting Health Care Center of H-city. In 2014, questionnaires were used to collect data about demographics, social activity, depression, frailty, and intention to participate in healthcare programs. The data were analyzed by descriptive statistics and multivariate logistic regressions. RESULTS: Among the participants, 51.8% intended to participate in the offered healthcare programs. The strongest factor affecting the intention was gender. Women were 4.85 times more likely to participate in the programs than men. The women's intention was associated positively with increased levels of frailty. The men tended to participate in the program as they got older and as the level of frailty and the number of chronic diseases increased. CONCLUSION: Gender-specific public healthcare programs for vulnerable elders living alone should be developed to maximize their participation in the programs and to promote good health. The healthcare programs must be tailored to the levels of the patients' physical functions.

The Attitude, Use and Adverse Effects of Complementary and Alternative Medicine (CAM) Therapies among Vulnerable, Community Dwelling Old Adults

PURPOSE: The purpose of this study is to obtain information of use of complementary and alternative medicines (CAMs) and any reported adverse effects of them on vulnerable elders in a community. METHODS: 1,837 elderly subjects aged 65 or higher with health problems were selected from those who were enrolled in a public health care center and received visiting health management services. A proportional stratified sampling method was used. Data collection was completed by face to face interviews using a structured questionnaire. The descriptive statistics and chi2-test were used to analyze the data. RESULTS: The prevalence of CAM use last year was 57.5%, and 10.4% of the subjects reported adverse effects of the therapies. The mean score of the subjects' attitudes towards CAM was 4.1+/-3.44 (range 1~10). The major sources of advice and exposure to CAM therapies were most likely to be from family and friends (72.5%). The primary reason for choosing CAM was to manage symptoms and relieve pain (86.6%). CONCLUSION: These findings suggest the need to develop nursing strategies for reducing and preventing adverse effects of CAM use by promoting awareness of using safe and appropriate CAM therapies.

Corrigendum: The Effects of a Cognitive Enhancement Group Training Program for Community-dwelling Elders

This erratum is being published to correct of Table 4.

The Effects of a Cognitive Enhancement Group Training Program for Community-dwelling Elders

PURPOSE: In this study a cognitive enhancement group training program of 10 sessions was provided for community-dwelling elders and the effects on cognitive function, depression and quality of life were tested. METHODS: A quasi-experimental study using a nonequivalent control group, pre-post design was used. The participants were 87 elders whose cognitive function was within the normal range. Of these elders, 45 were assigned to the experimental group and 42 to the control group. The intervention was conducted once a week for 10 weeks. Chi-square test, t-test, paired t-test, Wilcoxon rank sum test and Wilcoxon signed rank test were used to analyze the data. RESULTS: After the program, the cognitive function (t=-2.85, p=.006), depression (z=2.82, p=.005) and quality of life (t=2.79, p=.007) of the experimental group was significantly better than those of the control group. Especially, immediate recall (z=2.45, p=.014) and concentration (z=2.58, p=.010) in the subcategory of cognitive function were significantly better than that of the control group. CONCLUSION: The findings indicate that the cognitive enhancement group training program was effective in enhancing the cognitive function, depression and quality of life for elders and could therefore be considered as a positive program for emotional and cognitive support for community-dwelling elders.

Prevalence of Hyperhomocysteinemia and Related Factors in a Community-based Health Examination Survey: A Cross-sectional Study / 예방의학회지

BACKGROUND: Many previous studies have shown that elevated homocysteine in the serum is a well known risk factor for cardiovascular disease and this is associated with other risk factors for cardiovascular disease, but any Korean data on this is limited. OBJECTIVES: This study aimed to calculate the prevalence of hyperhomocysteinemia and to analyze the relation between elevated homocysteine and the lifestyle factors of Korean adults. METHODS: We conducted a cross-sectional survey that included 650 men and 743 women (age range, 20 to 79 years) who were residents of Gwangju City in Gyeonggi-do. These subjects participated in the health interview and examination survey from November to December 2005. The total homocysteine, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglyceride in the serum were measured. All the participants had their body composition measured such as height and weight, and we obtained health-related behavioral information through the self-entry questionnaire. RESULTS: Very right-handed skewed distributions of homocysteine were shown in men and women. The prevalence of hyperhomocysteinemia was 22.6% in men and 13.7% in women in Gwangju city. On the multiple logistic regression analysis, hyperhomocysteinemia was associated with age (OR=1.02, 95% CI=1.01-1.04), male gender (OR=1.60, 95% CI=1.02-2.52), severe general physical activity (OR=0.32, 95% CI=0.15-0.69) and nutrient consumption (OR=0.49, 95% CI=0.31-0.76). CONCLUSIONS: There is a great prevalence of hyperhomocysteinemia in adults of Gwangju City, Korea and it was associated with both genetic factors and lifestyle risk factors. This study can suggest that comprehensive lifestyle modification is needed in order to diminish the prevalence of hyperhomocysteinemia and to prevent CVD.

A Study on Health Behavior in People at Risk for a Cerebrovascular Accident / 간호학회지

PURPOSE: This study was done to survey health behaviors in people at risk for a Cerebrovascular Accident(CVA). METHOD: From November 21 to December 29, 2005, a questionnaire survey was conducted with 171 people at risk for a Cerebrovascular Accident(LDL of above 130 mg/dl & homocysteine of above 15.0 micromol/L). Their physical composition was measured and blood was collected. RESULTS: 1. Of the subjects, 34.5% were smokers, 61.4% were drinkers, 56.7% did not exercise regularly, 57.3% did not control their weight, 26.9% preferred eating meat, and 32.2% preferred salty food. 2. The gender was different between smoking status(Chi2=10.734, p= .001), and drinking status(Chi2=7.185, p= .007), and the age was different between smoking status(Chi2=6.656, p= .010), and drinking status(Chi2=10.722, p= .001). The HbA1C level was different for regular exercise(Chi2= 4.824, p=.028) and the HDL-cholesterol was different for meat-eating preference(Chi2=7.928, p= .005). The observance of troubling signs was different for a salty food preference(Chi2=4.313, p= .038). CONCLUSION: It is necessary to develop programs for taking care of people at risk for a Cerebrovascular Accident and test the effects of the programs in order to reduce the risk factors of CVA and enhance health behavior promotion.

Estimation of Nursing Costs by a Patient Classification System(PCS) in ICU / 간호학회지

PURPOSE: The objective of our study was to figure out costs of nursing services in ICU based on the PCS in order to determine an appropriate nursing fee schedule. METHOD: Data was collected from 2 hospitals from April 15-16 to April 22-23, 2003. The costs of nursing services in the ICU were analyzed by nursing time based on the nursing intensity. The inpatients in the ICU were classified by a PCS tool developed by the Korean Clinical Nurses Association(2000). RESULTS: The distribution of patients by PCS in the ICU ranged from class IV to Class VI. The higher PCS in ICU consumed more nursing time. As a result, the higher nursing intensity, the more the daily average nursing costs in the ICU. CONCLUSION: Our study provides evidence to refine the current nursing fee schedule that does not differentiate from the volume of nursing services based on nursing time. We strongly recommend that the current reimbursement system for nursing services should be applied not only to the general nursing units but also to the ICU or other special nursing units.

A Comparative Study of Korean and Korean-American Women in Their Health Beliefs related to Breast Cancer and the Performance of Breast Self-Examination / 간호학회지

PURPOSE: This cross-sectional survey was undertaken to examine the differences of BSE (breast-self examination) performance and health beliefs between Korean and Korean-American women and to identify which factors influence the BSE based on the HBM variables. METHOD: The study subjects were recruited from both Korea(189 women) and Cleveland in Ohio, USA(146 women). The HBM variables were measured using a reliable and valid Health Belief Model Scale. The subjects were also asked whether or not they did a BSE in the last year. RESULT: The Korean-American women who performed the BSE was statistically higher than that of Korean women. Regarding to the BSE-related health belief, the scores of benefits, confidence, and health motivation was significantly higher in Korean-American. After controlling for living places, age, education, and job, barriers and confidence variables significantly explained the BSE performance of Korean and Korean-American women. CONCLUSION: There was a differences in BSE-related health belief and performance between Korean and Korean-American women. Among health belief variables, barriers and confidence were core variables predicting the BSE performance of Korean and Korean-American women together.

Relationships of Smoking, Stress and Social Support of High School Students / 예방의학회지

OBJECTIVES: The purpose of the present study was to explore a possible interaction effect of stress and social support on the smoking status and identify smoking related factors of high school students. METHODS: A cross-sectional design was used for this study. A total of 1, 251 high school students from Gyeonggi-do were selected using stratified-proportional random cluster sampling methods. The participants completed a set of questionnaires to measure their smoking status, stress, social support and sociodemographic information. The obtained data were analyzed using descriptive statistics, x2-tests and hierarchical logistic regressions. RESULTS: The interaction effect of stress and social support on smoking status was not supported. However, stress, sex, types of school, parent's smoking and friends' smoking were significantly predicted the smoking status of the high school students. CONCLUSIONS: In relation to the prevention of adolescents' smoking, it is recommended to decrease the stress levels of students, to make adolescents' parents cease smoking, and to educate adolescents on how to refuse the temptation to smoke or pressure from their smoking friend.

Development and Application of the Critical Pathway in Perioperative Patients with Ventricular Septal Defect

BACKGROUND AND OBJECTIVES: Ventricular septal defect (VSD) is the most common congenital heart disease, and an effective cooperative practice system can change its therapeutic outcome. We tried to develop and find the effects of the application of the critical pathway (CP) in patients with VSD. MATERIALS AND METHODS: First, we reviewed the charts of patients diagnosed with VSD who had been operated on between January and December 1999, and the preliminary CP for the VSD completed. Second, the Delphi process was achieved by exchanging mail between two professional groups to establish the final CP for the VSD. This process was applied to thirteen patients having had operations at the Gil Heart Center between June and November 2000. On admission, the patients were informed of the practice, and their degree of satisfaction was anonymously surveyed prior to discharge. RESULTS: The CP for patients with VSD is composed of eight categories - monitoring, vital signs, laboratory tests, ventilator, diet (fluid-electrolyte balance), drugs, treatment, consultation and education. These were applied and evaluated daily from two days preoperatively, until the day of discharge (seven days postoperatively), to 13 of the 15 (86.7%) patients, as approved in the instruction manual. The duration of antibiotic injections significantly decreased from 5.3+/-1.3 days to 3.1+/-0.5 days (p=0.00002), as did that of thoracic tube insertion from 84+/-21 hours to 48+/-16 hours (p=0.0001). The degree of satisfaction of the parents was 4.2, the highest score possible being 5. CONCLUSION: Improvement in the quality of medicine can be achieved by developing and applying the CP to perioperative patients with VSD. Our conclusions from this study are only tentative as it was only applied to limited small number of cases.

The Classification of Standard Nursing Activities in Korea / 간호학회지

A nursing activity classification for hospitalized patients was performed based on an article review regarding nursing definition and nursing activity classification system. The study was conducted as follows: 1) Taxonomy was developed by the research team through the Delphi process and review article. The taxonomy consists of four nursing processes, (assessment, diagnosis, intervention and evaluation) and twelve nursing activity domains space (resperation, nutrition, elimination, exercise/alignment maintenance, comfort, hygiene, safety, spiritual support, counseling/ education, medication, communication, patient and information management). 2) First, nursing activities of the intervention process were listed and then classified by the nursing process of assessment, diagnosis, intervention and evaluation. The list consists of twelve nursing activity domains and 136 nursing activities. 3) A pilot study was conducted in two hospitals to verify validity and appropriateness of nursing activities. 4) The content validity index, which was calculated by 6 clinical practice experts, was 0.95. Also, a nursing activity classification system should also be developed in the department of community nursing and home health care nursing.

Attitudes toward Complementary and Alternative Medicine in Suwon City / 예방의학회지

OBJECTIVES: The aim of this study was to investigate the attitudes toward complementary and alternative medicine among 1,490 residents(339 households) in Suwon city. METHODS: All respondents were asked about types, frequency, effects, side-effects, views, and cost of complementary or alternative medicine through a questionnaire from July 24th to 27th. Six therapies were investigated: diet; acupuncture/ massage/ chiropractic etc.; mind control such as Ki/ Yoga/ spiritual therapy/ relaxation therapy etc.; nutritional supplements, cultural remedies; and Herb medications. RESULTS: The results of this survey were as follows: 35.6% of respondents had experiences with at least one or more types of complementary and alternative medicine. The average number of different types of therapies used was 3.4. More experience with various types of therapies were found among those respondents of higher education, older age group, higher income, married group, religious group than among the opposite groups of respondents. Herb medications were used most frequently(39.8%), followed by minor grains(37.9%), Ginseng(23.8%), Boshintang(21.5%), acupuncture(20.3%), Gaesojou (15.3%), Gingko nut(12.0%), mushroom(11.5%), Cupping therapy(10.2%), and black goat(0.0%). Acupuncture and Herb medications were used for treatment of hypertension the most frequently; minor grains or silkworm for treatment of diabetic mellitus; vegetables for treatment of obesity; acupuncture, Cupping Therapy, Herb medications for treatment of rheumatism; and acupuncture, Herb medications, or exercises for treatment of Cerebro Vascular Accident(CVA). The average costs of treatment were 108,000 Won for hypertension, 87,200 Won for diabetic mellitus, 16,800 Won for obesity, 68,800 Won for rheumatism, and 87,500 Won for CVA. Among 10.9% of respondents, there were 13 cases of side-effects with acupuncture, Herb medications, and Gaesojou. Among the cases of side-effects, majority was due to Herb medications. Respondents reported that Cupping Therapy was the most effective, followed by acupuncture, Ginseng, Gingko nut, Boshintang, black goat, minor grains, Gaesojou, Herb medications, vegetables, and mushroom. In response to the views of complementary and alternative medicine which they had used, they recommended minor grains first, followed by Ginseng, acupuncture, Gingko nut, Cupping Therapy, vegetables, Boshintang, black goat, mushroom and Herb medications. In contrast, they did not recommend Herb medications, acupuncture, nor Gaesojou. CONCLUSIONS: These findings indicate that many people use various complementary and alternative medicine without any guidelines for treatment of serious chronic diseases not even to invigorate themselves. It is, therefore, suggested that medical doctors or scientists verify the true effects or side-effects from the most common complementary or alternative therapies through experiments. Also medical doctors should provide a comfortable atmosphere for discussion among doctors and patients who would like to try these therapies.

The Effects of a Neurological Special Nursing and Early Rehabilitation Program on the Early Recovery of Patients with Acute Spontaneous Intracranial Hemorrhage and on the Level of Satisfaction of Patients' Families

This study was performed to evaluate the effects of a special nursing program on the recovery of patients with spontaneous intracranial hemorrhage, and on the level of satisfaction of their families. The experimental group comprised twenty patients selected from A university medical center, and the control group, nineteen patients selected from B university medical center. Patients with cormorbidity were not included. Between 1 October, 1995 and 30 April, 1996, personnel specialized in neurosurgical nursing provided the experimental group with a special nursing program, while the control group was offered general nursing services. The key elements of this special nursing program were close observation to identify potential risk factors ; crisis intervention to prevent gaps in medical service delivery ; patient-centered care emphasizing early recovery, including specific protocols for the prevention of disability and for rehabilitation ; and patient education and counseling to maximize satisfaction. The average length of stay in ICU, neurological status, functional status, impact of complications, and satisfaction level were measured through medical records, the Glasgow Coma Scale, Functional Independence Measurement, patient assessments, and questionnaires, respectively. These data were analyzed by paired t-test, independent-samples t-test, and ANOVA, and the results were as follows : 1) The average length of stay in ICU of the experimental group was significantly shorter than that of the control group. 2) The degree of neurological recovery of the experimental group between admission and the second week after operation was not significantly different from that of the control group. 3) The impact of complications on the control group was greater than on the experimental group. 4) Between the first and second week after operation, the functional status of the experimental group changed more noticeably than that of the control group. 5) The degree of satisfaction with the nursing services was higher among the families of patients in the experimental group than among the other families. These findings indicate that a special nursing program might improve the recovery of patients with spontaneous intracranial hemorrhage and increase the satisfaction of their families. It is therefore suggested that in order to provide comprehensive medical services to patients with spontaneous intracranial hemorrhage, personnel such as neurosurgical nursing specialist be appropriately utilized. In addition, the current medical insurance fee schedule especially in relation to the cost of rehabilitation, should be adjusted to cover broader services.

A Survey of Students' Opinions on Evaluation and Refinement the New Teaching Program Of Medical Ethics / 한국의학교육

This survey was performed for evaluating and refining the new teaching program for medical ethics which was developed by faculities in Ajou university. Most of the students showed interest and satisfactions as well as con fidences in ethical judgement through the new course of medical ethics. Specific evaluation was as follows; Most of cases in discussion and debates were appropriate for understanding of medical ethical issues. They expressed that they learned how to collaborate in group, accept different opinions and views, build a sense of sharing community and work with an indivisual resposibility. Several ideas for improving medical ethics cirricula were suggested that some cases should be replaced to realistic cases, more clinicians from relevant departments should be involved in discussion, and educational environment should be changed to discuss and debate easily.

A New Direction for Teaching Medical Ethics / 한국의학교육

Drawing on our observation that many medical professionals have considerable difficulty in using what they know about ethics, we have developed a course for teaching the fifth year medical students a systematic approach to ethical reasoning and problem-solving, rather than teaching bioethical theories or prominent current ethical issues in developed countries. This course consisted of a series of guided group discussions and debates in classroom using over 50 cases classified under seven major headings. Responses and reactions from students and participating clinicians are encouraging. Several ideas for improving medical ethics curricula are discussed, including emphases on the thorough understanding of various aspects of human relations in medical practice, enhancing the ability of articulate the students own values, provoking the student to get involved in the ethical situation when studying the cases, and the need to introduce social science concepts in analyzing the ethical issues in the health care system.