Changes in Dietary Behavior of Shift Work Nurses: A Longitudinal Study / 간호행정학회지

Purpose@#This study aimed to identify the changes in dietary behavior of shift work nurses and its influencing factors over time. @*Methods@#This was a secondary data analysis study based on the Shift Work Nurses’ Health and Turnover study. Data of 165 shift work nurses, who were followed for three-time points [before shift work (T0), after 6 months (T1), and after 18 months(T2) of shift work], were analyzed. Dietary behavior, level of stress, fatigue, depressive symptoms, and the amount of physical activity were measured. SPSS 28.0 was used to analyze the data to acquire descriptive statistics, repeated-measures ANOVA, and multiple linear regression with generalized estimating equations (GEE). @*Results@#Dietary behavior of shift work nurses was poorer at T1 and T2 as compared to T0. As a result of GEE, shift work duration, level of stress, fatigue, and depressive symptoms were found to have negative impacts on dietary behavior. @*Conclusion@#Dietary behavior deteriorated and remained poor over time since shift work began. Shift work, along with stress, fatigue, and depressive symptoms, were the factors influencing their dietary behavior. Thus, to improve shift work nurses’ dietary behavior, efforts to decrease stress, and alleviate fatigue and depressive symptoms are urgently required.

Changes in Stress, Occupational Stress, and Subjective Health Problems of Novice Female Nurses: Secondary Data Analysis

Purpose@#This study aimed to examine the changes in stress, occupational stress, and subjective health problems of novice female nurses within the first 18 months of work. @*Methods@#This was a longitudinal study conducted with a secondary data analysis based on the Shift Work Nurse’s Health and Turnover (SWNHT) study. The participants were 178 female novice nurses who participated in all 3 data collection activities (on the first day of orientation before ward placement [T0], 6 months after work [T1], and 18 months after work [T2]). The stress, occupational stress, 8 subjective health problems (upper musculoskeletal pain, leg/foot discomfort, depression, anxiety or emotional disorder, sleep disturbance, headache, gastrointestinal disorder, menstrual disorder, and others), and the greatest health problem during the study period were measured, respectively. Data were analyzed using SPSS 26.0 to obtain descriptive statistics. @*Results@#The subjective health of novice female nurses were found to be poor at T1 compared to T0 on both physical (upper musculoskeletal pain, leg/foot discomfort, and sleep disturbance) and psychological health problems (depression and stress). However, the psychological health problems of the participants were alleviated at T2 whereas; physical health problems persisted until T2. @*Conclusion@#Novice nurses had poor health problems 6 months after work. Sleep disturbance and musculoskeletal pain persisted although other health problems such as depression and stress were alleviated over the period. Strategies to prevent and manage different health problems of novice female nurses at different work duration are urgently needed.

Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger / 대한뇌졸중학회지

Background@#and Purpose Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied. @*Methods@#This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim’s criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP. @*Results@#A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP. @*Conclusions@#The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.

Comparison of Occupational Stress and Health Problems between Leavers and Stayers: Focused on Novice Nurses

Purpose@#This study aimed to identify occupational stress and health problems as well as turnover reasons among leavers in novice nurses and to estimate factors which might affect turnover by comparing them to stayers. @*Methods@#In this study, secondary analysis of data gathered from the Shift Work Nurse’s Health and Turnover studies, was carried out. The data were collected from 204 stayers who have been working for 18 months since 2018 and 48 leavers who left within the same period at two tertiary hospitals in Seoul. The reasons for turnover, occupational stress, and 8 types of health problems were recorded. The data were analyzed using SAS 9.4 to obtain descriptive statistics. In parallel, Pearson’s chi-squared test, Fisher’s exact test, and independent t-test were also conducted. @*Results@#The main reasons for turnover were job stress and difficult interpersonal relationships in the workplace. Occupational stress of leavers was higher than stayers, especially in the subscales of interpersonal conflict, organizational system, lack of reward, and occupational climate. Among the 8 types of health problems, the depression prevalence of leavers was higher compared to stayers and showed marginal significance. Unexpectedly, the sleep disturbance prevalence of stayers was significantly higher compared to leavers. @*Conclusion@#To reduce the turnover rate of novice nurses, education on how to cope with occupational stress is needed. A customized program for novice nurses to overcome the difficulties of interpersonal relations would be helpful.

Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger / 대한뇌졸중학회지

Background@#and Purpose Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied. @*Methods@#This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim’s criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP. @*Results@#A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP. @*Conclusions@#The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.

Comparison of Occupational Stress and Health Problems between Leavers and Stayers: Focused on Novice Nurses

Purpose@#This study aimed to identify occupational stress and health problems as well as turnover reasons among leavers in novice nurses and to estimate factors which might affect turnover by comparing them to stayers. @*Methods@#In this study, secondary analysis of data gathered from the Shift Work Nurse’s Health and Turnover studies, was carried out. The data were collected from 204 stayers who have been working for 18 months since 2018 and 48 leavers who left within the same period at two tertiary hospitals in Seoul. The reasons for turnover, occupational stress, and 8 types of health problems were recorded. The data were analyzed using SAS 9.4 to obtain descriptive statistics. In parallel, Pearson’s chi-squared test, Fisher’s exact test, and independent t-test were also conducted. @*Results@#The main reasons for turnover were job stress and difficult interpersonal relationships in the workplace. Occupational stress of leavers was higher than stayers, especially in the subscales of interpersonal conflict, organizational system, lack of reward, and occupational climate. Among the 8 types of health problems, the depression prevalence of leavers was higher compared to stayers and showed marginal significance. Unexpectedly, the sleep disturbance prevalence of stayers was significantly higher compared to leavers. @*Conclusion@#To reduce the turnover rate of novice nurses, education on how to cope with occupational stress is needed. A customized program for novice nurses to overcome the difficulties of interpersonal relations would be helpful.

Secondary Data Analysis on the Factors Influencing Premenstrual Symptoms of Shift Work Nurses:Focused on the Sleep and Occupational Stress

Purpose@#This study aimed to examine premenstrual symptoms (PMS) of shift nurses and identify the association between PMS, sleep, and occupational stress. @*Methods@#This study was conducted with a secondary data analysis that used data from the Shift Work Nurse’s Health and Turnover study. The participants were 258 nurses who were working in shifts including night shifts. PMS, sleep patterns (sleep time and sleep time variability), sleep quality, and the occupational stress of each participant were measured using the Moos Menstrual Distress Questionnaire, a sleep diary, an actigraph, the Insomnia Severity Index, and the Korean Occupational Stress Scale, respectively. Data were analyzed using SPSS 23 and STATA 15.1 to obtain descriptive statistics, Pearson’s correlation coefficients, multiple linear regression with generalized estimating equations (GEE) and Baron and Kenny’s mediating analysis. @*Results@#The average PMS score, average sleep time, average sleep time variability, average sleep quality score, and average occupational stress score of the participants was 53.95 ± 40.45, 7.52 ± 0.89 hours, 32.84 ± 8.43%, 12.34 ± 5.95, and 49.89 ± 8.98, respectively. A multiple linear regression analysis with GEE indicated that sleep time variability (B = 0.86, p = .001), and sleep quality (B = 2.36, p < .001) had negative effects on nurses’ PMS. We also found that sleep quality had a complete mediating effect in the relationship between occupational stress and PMS. @*Conclusion@#These findings indicate that both sleep time variability and sleep quality are important factors associated with PMS among shift work nurses. To improve shift nurses’ PMS status, strategies are urgently needed to decrease sleep time variability and increase sleep quality.

The Factors Associated with Dietary Knowledge and Educational Needs of Stroke Patients

Purpose@#The purpose of the this study was to examine the dietary knowledge and educational needs of stroke patients and analyze the related factors that are associated with dietary knowledge and educational needs. @*Methods@#Our study analyzed data from 146 stroke patients. The survey was conducted by individual interviews using questionnaires and data collected from participants’ medical records. Dietary knowledge and educational needs were measured by tools developed by the author. @*Results@#The mean scores for the dietary knowledge and educational needs were 19.09± 3.48 and 36.17± 7.18, respectively. Many stroke patients had misconceptions about soy sauce, cholesterol, and fruits. The most needed items in dietary education was first identifying foods that are beneficial or harmful, and second, food interaction with medications. As for the results of multiple regressions, dietary knowledge was significantly associated with gender, educational attainment, monthly income, exercise, body mass index, and level of compliance to dietary therapy. Additionally, the educational needs were significantly related with educational attainment and employment. @*Conclusion@#For secondary prevention of stroke patients, education strategy considering dietary knowledge and educational needs of stroke patients should be established. Special attention is needed for stroke patients with a lower level of dietary knowledge and educational needs.

Health Promoting Behavior and Factors in Operating Room nurses

PURPOSE: This study aimed to investigate the level and related factors related to health-promoting lifestyle in operating room nurses in Korea.METHODS: A cross-sectional descriptive survey design was employed. The data were collected using questionnaire for three weeks in December 2018 from 110 operating room nurses working for more than six months in a general hospital located in Seoul. The Health Promoting Lifestyle Profile-II, The Korean Version of the Practice Environment Scale of Nursing Work Index, and Operating nurse's Job stress Factor Scale were used.RESULTS: Significant relationships were observed between health promoting lifestyle and educational level(p=.025), perceived economic status (p=.001) wearing a lead apron for protection from radiation during the operation(p < .001), work satisfaction(p=.016), and fatigue related to work(p=.006). Also significant correlations were identified between nursing work environment and health promoting lifestyle. However, the health promoting lifestyle was not statistically different based on occupational stress(p=.365). In multiple linear regression analyses, the level of health promoting lifestyle found to be higher in subjects who did not wear a lead apron for protection from radiation(p=.017), and who had more positive perception of the nursing work environment(p=.034).CONCLUSION: In order to increase health promoting lifestyle of operating nurses, the strategies to improve the nursing work environment are essential.

Nutritional Status of Liver Transplantation Recipients and Factors Influencing Nutritional Status

PURPOSE@#This study aimed to investigate the nutritional status of liver transplantation (LT) recipients and explore certain factors that influence nutritional status, including dietary patterns and physical activities.@*METHODS@#This was a cross-sectional, descriptive study. The subjects included 211 LT recipients at a medical center outpatient clinic located in Seoul, Korea. The nutritional status, dietary patterns, and physical activities of each subject were measured using the body mass index (BMI), Mini Dietary Assessment (MDA), and Global Physical Activity Questionnaire. Independent t-test, one-way analysis of variance, and multiple linear regression analysis were used to analyze the data.@*RESULTS@#The percentages of living and deceased donor LTs were 81.0% and 19.0%, respectively. The mean BMIs pre- and post-LT were 23.88 and 23.16 kg/m2, respectively, and the average MDA score was 36.55. More than 60.0% of the subjects had a moderate or high level of physical activity. In multivariate analysis, a higher BMI before LT (β=.72, p<.001), a lower Model for End-stage Liver Disease (MELD) score (β=−.18, p<.001), and being male (β=−.10, p=.024) contributed to better nutritional status post-LT. Patients within six months of LT were less engaged in muscle exercises than those post six months of LT (p=.020).@*CONCLUSION@#LT recipients in Korea have good nutritional status and a good level of physical activity. To improve recipients' post-LT nutritional status, the pre-LT nutritional status should be considered, particularly in those with a higher MELD score. In addition, physical activity including muscle-strengthening exercises should be encouraged from an earlier stage.

Effects of a Laughter Therapy on Depression, Anxiety, Fatigue and Quality of Sleep in Gastrointestinal Cancer Patients Post-Treatment: a Randomized Controlled Trial

PURPOSE: The purpose of this study was to examine the effect of laughter therapy on depression, anxiety, fatigue, and quality of sleep in gastrointestinal cancer survivors. METHODS: This study was a randomized controlled trial. We compared the effect of laughter therapy with usual care only in post chemotherapy gastrointestinal patients. Outcomes included changes in depression and anxiety (according to the Hospital Anxiety and Depression Scale), fatigue (according to the Fatigue Severity Scale), and quality of sleep (according to the Verran & Synder-Halpern Sleep Scale). Data was collected July 2015 through January 2016. Seventy nine participants who agreed to participate in this study were randomized to either the experimental group (n=40) or the control group (n=39). Therapy included eight sessions (60 minutes each, once weekly). Data were analyzed using the Windows SPSS 22.0 program. RESULTS: Laughter therapy was effective in reducing fatigue (p=.019) and increasing satisfaction of sleep (p=.030). There were no differences between the groups after therapy for depression (p=.129) and anxiety (p=.200). CONCLUSION: Results of this study indicate that laughter therapy may be an effective nursing intervention for improving the health status of gastrointestinal cancer survivors after chemotherapy.

Nutritional Status of Liver Transplantation Recipients and Factors Influencing Nutritional Status

PURPOSE: This study aimed to investigate the nutritional status of liver transplantation (LT) recipients and explore certain factors that influence nutritional status, including dietary patterns and physical activities. METHODS: This was a cross-sectional, descriptive study. The subjects included 211 LT recipients at a medical center outpatient clinic located in Seoul, Korea. The nutritional status, dietary patterns, and physical activities of each subject were measured using the body mass index (BMI), Mini Dietary Assessment (MDA), and Global Physical Activity Questionnaire. Independent t-test, one-way analysis of variance, and multiple linear regression analysis were used to analyze the data. RESULTS: The percentages of living and deceased donor LTs were 81.0% and 19.0%, respectively. The mean BMIs pre- and post-LT were 23.88 and 23.16 kg/m2, respectively, and the average MDA score was 36.55. More than 60.0% of the subjects had a moderate or high level of physical activity. In multivariate analysis, a higher BMI before LT (β=.72, p<.001), a lower Model for End-stage Liver Disease (MELD) score (β=−.18, p<.001), and being male (β=−.10, p=.024) contributed to better nutritional status post-LT. Patients within six months of LT were less engaged in muscle exercises than those post six months of LT (p=.020). CONCLUSION: LT recipients in Korea have good nutritional status and a good level of physical activity. To improve recipients' post-LT nutritional status, the pre-LT nutritional status should be considered, particularly in those with a higher MELD score. In addition, physical activity including muscle-strengthening exercises should be encouraged from an earlier stage.

Differences in Therapeutic Responses and Factors Affecting Post-Stroke Depression at a Later Stage According to Baseline Depression / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: The pathophysiology of post-stroke depression (PSD) is complex and may differ according to an individual’s mood immediately after stroke. Here, we compared the therapeutic response and clinical characteristics of PSD at a later stage between patients with and without depression immediately after stroke. METHODS: This study involved a post hoc analysis of data from EMOTION (ClinicalTrials.gov NCT01278498), a placebo-controlled, double-blind trial that examined the efficacy of escitalopram (10 mg/day) on PSD and other emotional disturbances among 478 patients with acute stroke. Participants were classified into the Baseline-Blue (patients with baseline depression at the time of randomization, defined per the Montgomery-Asberg Depression Rating Scale [MADRS] ≥8) or the Baseline-Pink groups (patients without baseline depression). We compared the efficacy of escitalopram and predictors of 3-month PSD (MADRS ≥8) between these groups. RESULTS: There were 203 Baseline-Pink and 275 Baseline-Blue patients. The efficacy of escitalopram in reducing PSD risk was more pronounced in the Baseline-Pink than in the Baseline-Blue group (p for interaction=0.058). Several risk factors differentially affected PSD development based on the presence of baseline depression (p for interaction < 0.10). Cognitive dysfunction was an independent predictor of PSD in the Baseline-Blue, but not in the Baseline-Pink group, whereas the non-use of escitalopram and being female were more strongly associated with PSD in the Baseline-Pink group. CONCLUSIONS: Responses to escitalopram and predictors of PSD 3 months following stroke differed based on the presence of baseline depression. Our data suggest that PSD pathophysiology is heterogeneous; therefore, different therapeutic strategies may be needed to prevent PSD emergence following stroke.

Literature Review of Postoperative Delirium in Geriatric Patients After Elective Gastrointestinal Cancer Surgery

PURPOSE: Increasing number of older adults are receiving cancer surgeries especially for gastrointestinal cancers, which brings forth attention to age-related postoperative complication prevention. Postoperative delirium (POD) is a common complication that rises after surgical procedures involving general anesthesia, largely in the elderly population. Due to its sudden onset and fluctuating symptoms, POD often goes underdiagnosed and undertreated even though it may lead to various adverse outcomes. POD in GI cancer surgical elderly patients is poorly understood in terms of prevalence, pathophysiology, assessment, treatment and nursing management. We aimed to identify available literature and investigate study results to broaden our understanding of geriatric GI cancer POD. METHODS: The search process involved six databases to identify relevant studies abided by inclusion criteria. RESULTS: Eleven studies were selected for this review. Geriatric POD is closely related to frailty and surgical complications. Frailty increases vulnerability to surgical stress and causes cerebral changes that affect stress-regulating neurotransmitter proportions, brain blood flow, vascular density, neuron cell life and intracellular signal transductions. These conditions of frailty result in increased risks of surgical complications such as blood loss, cardiovascular events and inflammation, which all may lead to the POD. Mini Metal State Examination (MMSE), Confusion Assessment Method (CAM) and Delirium Rating Scale-revised-98 (DRS-R-98) are recommended for POD assessment to identify high-risk patients. CONCLUSION: The POD prevalence ranged from 8.2% to 51.0%. The multifactorial causative mechanism suggests nurses to identify highrisk elderly GI-cancer surgical patients by reviewing patient-specific factors and surgery-specific factors.

Association of Sleep Disturbance, Fatigue, Job Stress and Exposure to Blood and Body Fluid in Shift-work Nurses

PURPOSE: The purpose of this study was to identify associations among the sleep disturbance, fatigue, job stress, and blood and body fluid (BBF) exposure of shift-work nurses. METHODS: A total of 299 shift-work nurses from two tertiary hospitals were enrolled in this study. We used the Insomnia Severity Index (ISI), and the Fatigue Severity Scale (FSS), and the Korean Occupational Stress Scale-Short Form (KOSS-SF) to evaluate sleep disturbance, fatigue, and job stress, respectively. The data were analyzed using t-test or chi-squared test and Logistic regression analysis using the SPSS 23.0 program. RESULTS: We found that 43.8% of participants reported BBF exposure over the past year. Splash or exposure to broken skin of BBF were most frequent (56.9%), and followed by needlestick injuries (30.4%) and sharp injuries (12.8%). Age, hospital, working period, level of stress, sleep disturbance (ISI≥15), fatigue (FSS score≥4), job demand and organizational climate subset in KOSS-SF were significantly associated with BBF exposure in shift-work nurses. In multivariate analysis after adjusting age and hospital, the risk factors of BBF exposure in shift-work nurses were the level of stress and fatigue (FSS score≥4). CONCLUSION: Fatigue and job stress were related to BBF exposure in shift-work nurses. Our results suggest that management of sleep disturbance, fatigue, and high job stress in shift-work nurses is needed to reduce risk of BBF exposure.

Current Status of Biological Nursing Science Education for Clinical Nurses in General Hospital

PURPOSE: The purpose of this study was to investigate the extent and the nature of biological nursing science education for clinical nurses in general hospital. METHODS: Five advanced general hospitals located in Seoul and Gyeonggi province were conveniently sampled. Contents of education for nurses conducted by the hospital nursing department from January 1 to December 31 of 2015 were collected. Contents of education included biological nursing science and the scope of inclusion and time of assignment were analyzed. RESULTS: A total of 271 cases of nursing education data were collected and 223 cases were analyzed after excluding 48 cases whose contents were not confirmed. Biological nursing science was included in the contents of education for 117 cases (52.5%), but not for 106 cases (47.5%). Regarding the frequency of the biological nursing science education contents, ‘pathophysiology’was the most frequently included (n=286), followed by ‘structure and function of the human body’ (n=191), ‘mechanisms and effects of drugs’ (n=114) and ‘clinical microbiology’ (n=43). CONCLUSION: Results of this study confirmed that the education for clinical nurses included a lot of biological nursing science related contents. These results can be used as basis for the development of curriculum and training course for nurses.

The Relationships among Chemotherapy-Induced Nausea and Vomiting (CINV), Non-Pharmacological Coping Methods, and Nutritional Status in Patients with Gynecologic Cancer

PURPOSE: Chemotherapy-induced nausea and vomiting (CINV) can cause severe malnutrition. However, relationships between CINV levels, non-pharmacological coping methods, and nutritional status of female cancer patients have rarely been investigated. Therefore, this study aimed to analyze their relationships in gynecologic cancer patients. METHODS: Participants receiving a highly and moderately emetogenic chemotherapy were recruited. The level of CINV was assessed using a numeric rating scale. Coping methods were determined using multiple-choice self-report questionnaires and categorized into seven types for statistical analysis. Nutritional status was evaluated using biochemical and anthropometric parameters. RESULTS: Among all the 485 patients, 200 eligible inpatients were included. Despite the administration of prophylactic antiemetics, 157 patients (78.5%) still experienced CINV, and several used nonmedically recommended coping methods, such as just enduring the symptom or rejecting food intake. A total of 181 patients (90.5%) had nutritional disorders. Although the level of CINV was indirectly related to the occurrence of nutritional disorders, patients who rejected food (β=1.57, p=.023) and did not use physical measures (β= −1.23, p=.041) as coping methods were under the high risk of nutritional disorders. CONCLUSION: Korean gynecologic cancer patients had high levels of CINV and were at high risk of nutritional disorders, which may be related to the use of nonscientific coping methods, possibly due to cultural backgrounds and lack of proper nutritional program. Therefore, developing a culturally appropriate educational program for the cancer patients with CINV is urgently needed.

The Effects of Korean DASH Diet Education Program on Oxidative Stress, Antioxidant Capacity, and Serum Homocysteine Level among Elderly Korean Women

PURPOSE: The purpose of this study was to investigate the effects of the Korean Dietary Approaches to Stop Hypertension (DASH) education program on oxidative stress, antioxidant capacity, and serum homocysteine (Hcy) level in elderly Korean women. METHODS: This was a quasi-experimental study employing non-equivalent control group pretest-posttest design. The DASH group (n=27) underwent the DASH education program for 12 weeks, whereas the control group (n=21) was provided one education session. The survey was conducted before and after the intervention period. RESULTS: In DASH group, monounsaturated fatty acid (MUFA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) intakes significantly increased after the intervention as compared to prior to the intervention. No significant differences were found in the control group. After the intervention, thiobarbituric acid reactive substance (TBARS) and Hcy levels significantly decreased in the DASH group but not in the control group. CONCLUSION: The DASH education program was effective in reducing oxidative stress and Hcy levels in elderly Korean women.

Sleep Patterns, Alertness and Fatigue of Shift Nurses according to Circadian Types

PURPOSE: The purpose of this study was to identify sleep patterns, alertness, and fatigue of shift nurses according to circadian types. METHODS: The researchers' enrolled 17 nurses doing shift work in a tertiary hospital. To evaluate circadian types, a morningness-eveningness questionnaire (MEQ) was administered. Sleep patterns were examined using an actigraph for 14 days. To assess alertness and fatigue, Visual Analogue Scale (VAS) was used. The data were analyzed using ANOVA and Kruskal-Wallis test with a SPSS 21.0 program. RESULTS: The researchers found that 17.6% of participants reported morning type, 47.1% neither type, and 35.3% evening type. Mean total sleep time (TST) was 6.8 h, mean sleep efficacy was 82%, level of alertness was 6.54, and level of fatigue was 5.49, regardless of the type of shift work. Evening type nurses had higher variation in TST and alertness, according to the shift patterns than other circadian type nurses. Evening type nurses also had higher fatigue levels than other circadian type nurses. CONCLUSION: Sleep, alertness, and fatigue were related with circadian types. These results suggest that circadian rhythm management in shift work nurses, particularly in evening type nurses is urgently needed to improve sleep patterns, alertness, and to decrease the level of fatigue.

Effectiveness of Self-efficacy Promoting Vestibular Rehabilitation Program for Patients with Vestibular Hypofunction

PURPOSE: In this study an examination was done of the effect of self-efficacy promoting vestibular rehabilitation (S-VR) on dizziness, exercise selfefficacy, adherence to vestibular rehabilitation (VR), subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness in patients with vestibular hypofunction. METHODS: This was a randomized controlled study. Data were collected 3 times at baseline, 4 and 8 weeks after beginning the intervention. Outcome measures were level of dizziness, exercise self-efficacy, and level of adherence to VR. Subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness were also obtained. Data were analyzed using Windows SPSS 21.0 program. RESULTS: After 4 weeks of S-VR, there was no difference between the groups for dizziness, subjective and objective vestibular functions. However, exercise self-efficacy and adherence to VR were higher in the experimental group than in the control group. After 8 weeks of S-VR, dizziness (p =.018) exercise self-efficacy (p <.001), adherence to VR (p <.001), total-dizziness handicap inventory (DHI) (p =.012), vision analysis ratio (p =.046) in the experimental group differ significantly from that of the control group. The number of patients with recurring dizziness were higher in the control group than in the experimental group (p <.001). CONCLUSION: The results indicate that continuous 8 weeks of S-VR is effective in reducing dizziness, and improving exercise self-efficacy, subjective vestibular function and adherence to VR. Objective vestibular function and vestibular compensation were also improved in the experimental group at the end of 8 weeks of S-VR.