Implications for clinical practice from a multicenter survey of heart failure management centers

OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

Hand Function Rehabilitation Management Program after Burn: Based on Knowledge to Action Framework / 中国康复理论与实践

Objective:To construct a management program of hand function rehabilitation for adult inpatients after hand burn. Methods:Literatures of clinical practice guideline, evidence summary, systematic review and review were searched from OVID JBI, Cochranel Library, EBSCO, PubMed、EMbase、FEBM, CNKI, Wanfang Data and CBM, and so on. They were screened, evaluated, extracted evidence, found hinder factors following the steps of Knowledge to Action (KTA). Finally, a hand function rehabilitation management program was constructed. Results:Ten literatures were included. The management program included hand function rehabilitation intervention program and implementation procedures. Conclusion:Based on KTA framework, the hand function rehabilitation management program after burn can be used in clinic.

Hand Function Rehabilitation Management Program after Burn: Based on Knowledge to Action Framework / 中国康复理论与实践

Objective:To construct a management program of hand function rehabilitation for adult inpatients after hand burn. Methods:Literatures of clinical practice guideline, evidence summary, systematic review and review were searched from OVID JBI, Cochranel Library, EBSCO, PubMed、EMbase、FEBM, CNKI, Wanfang Data and CBM, and so on. They were screened, evaluated, extracted evidence, found hinder factors following the steps of Knowledge to Action (KTA). Finally, a hand function rehabilitation management program was constructed. Results:Ten literatures were included. The management program included hand function rehabilitation intervention program and implementation procedures. Conclusion:Based on KTA framework, the hand function rehabilitation management program after burn can be used in clinic.

Evaluation of the Effectiveness and the Level of Self-Management Support on the Metabolic Syndrome Management Program at Public Health Centers in Seoul Metropolitan City / 보건행정학회지

BACKGROUND: The purpose of this study was to evaluate the effectiveness and the level of self-management support on the Metabolic Syndrome Management Program at public health centers in Seoul metropolitan city. METHODS: The effectiveness on the Metabolic Syndrome Management Program were analyzed using secondary data from 1,312 community residents who were receiving program. The level of self-management support on Metabolic Syndrome Management Program was evaluated using an ‘Assessment of Primary Care Resources and Supports for Chronic Disease Self-Management’ from four public health centers. RESULTS: The effectiveness on the Metabolic Syndrome Management Program was showed that decreased smoking (p=0.044) and drinking (p<0.001), and increased healthy dietary habit (p<0.001) in health behaviors. It was showed that decreased triglyceride (p=0.002) and increased high-density lipoprotein cholesterol (p<0.001) in clinical indicators. The level of self-management support on Metabolic Syndrome Management Program was 98.1 points and it meaned that implementation is done in an organized and consistent manner using a team approach. There was difference in the level of self-management support by public health centers (p=0.003). CONCLUSION: The Metabolic Syndrome Management Program in public health centers was effective, and level of self-management support was done as organizational level, but patient input and mental health were insufficient.

Cost-benefit Analysis of Nutrition Management Program for Children Aged Under 5 Years in DR Congo / 대한지역사회영양학회지

OBJECTIVES: This study aims to evaluate the economic efficiency of a nutrition management program for children under 5 years of age in Kenge, Kwango District, Democratic Republic of the Congo (DR Congo) from 2014 to 2016. METHODS: The economic efficiency of a nutrition management program for children under 5 years of age who have recovered from malnutrition status was evaluated using a cost-benefit analysis. The costs were analyzed according to the executed budget incurred during the project period. The benefits were estimated as the monetary value of the saved lives of children under 5 years of age. The economic efficiency of the program was determined by the Benefit-Cost Ratio (BCR). The BCR was calculated by dividing the total discounted benefit by the total discounted costs. The project is economically efficient when the BCR is greater than 1. RESULTS: The costs of the nutrition management program were calculated as 1,677,609,648 Korean Won (KRW). A total of 2,466 children survived with improved malnutrition status through this program. The benefit for the reduction of mortality for children under 5 years of age was estimated to be 6,814,354,467 KRW, the estimated value of life for 2,466 children. The BCR was 4.06. CONCLUSIONS: The nutrition management program for children under 5 years of age in DR Congo was found to be a cost-effective project. Successful and efficient Official Development Assistance (ODA) for a health project requires integrated and comprehensive strategies and specialized international development consulting to improve efficiency. Future nutrition management programs should take into account the national health program to maintain the sustainability of the project.

Cost-benefit Analysis of Nutrition Management Program for Children Aged Under 5 Years in DR Congo / 대한지역사회영양학회지

OBJECTIVES: This study aims to evaluate the economic efficiency of a nutrition management program for children under 5 years of age in Kenge, Kwango District, Democratic Republic of the Congo (DR Congo) from 2014 to 2016. METHODS: The economic efficiency of a nutrition management program for children under 5 years of age who have recovered from malnutrition status was evaluated using a cost-benefit analysis. The costs were analyzed according to the executed budget incurred during the project period. The benefits were estimated as the monetary value of the saved lives of children under 5 years of age. The economic efficiency of the program was determined by the Benefit-Cost Ratio (BCR). The BCR was calculated by dividing the total discounted benefit by the total discounted costs. The project is economically efficient when the BCR is greater than 1. RESULTS: The costs of the nutrition management program were calculated as 1,677,609,648 Korean Won (KRW). A total of 2,466 children survived with improved malnutrition status through this program. The benefit for the reduction of mortality for children under 5 years of age was estimated to be 6,814,354,467 KRW, the estimated value of life for 2,466 children. The BCR was 4.06. CONCLUSIONS: The nutrition management program for children under 5 years of age in DR Congo was found to be a cost-effective project. Successful and efficient Official Development Assistance (ODA) for a health project requires integrated and comprehensive strategies and specialized international development consulting to improve efficiency. Future nutrition management programs should take into account the national health program to maintain the sustainability of the project.

Effective Management Interval Focused on Professional Mechanical Tooth Cleaning / 치위생과학회지

This study was conducted to investigate the optimal management interval in 33 healthy adults by observing changes in oral health on the basis of the plaque control index and gingival index. When plaque control score was compared according to the period, it was found that oral hygiene management was the best in the fourth visit (p0.05). The questionnaire survey showed, that the optimal management interval was 1, 3, and 6 months. As a result, with the effective management interval for the preventive management program focused on professional mechanical tooth cleaning, which was administered weekly, the maximum ability for oral hygiene management was attained at the fourth visit. The effective management period was 1 month. The use of a phase contrast microscope and the calculation of the evaluation index for oral hygiene management could influence the motivation to improve oral hygiene management.

Management of high-value consumables based on No.1 Military Medical Project / 医疗卫生装备

Objective To solve the problems of hospital high-value consumables during purchase,warehouse-in and-out management,utilization,charging and etc.Methods High-value consumables management was improved based on No.1 Military Medical Project high-value consumables management system and bar code technology.Results Integrated management,whole-course supervision,safe utilization,convenient and accurate charging were realized for high-value consumables.Conclusion Bar code technology contributes to reducing high-value consumables inventory,decreasing hospital cash flow pressure,achieving high value consumables used safely and zero error valuation of financial accounting.It can become an effective management mode of hospital high-value consumables.

Management of high-value consumables based on No.1 Military Medical Project / 医疗卫生装备

Objective To solve the problems of hospital high-value consumables during purchase,warehouse-in and-out management,utilization,charging and etc.Methods High-value consumables management was improved based on No.1 Military Medical Project high-value consumables management system and bar code technology.Results Integrated management,whole-course supervision,safe utilization,convenient and accurate charging were realized for high-value consumables.Conclusion Bar code technology contributes to reducing high-value consumables inventory,decreasing hospital cash flow pressure,achieving high value consumables used safely and zero error valuation of financial accounting.It can become an effective management mode of hospital high-value consumables.

Needs for Development of IT-based Nutritional Management Program for Women with Gestational Diabetes Mellitus / 대한지역사회영양학회지

OBJECTIVES: The aim of this study was to examine self-management status, nutritional knowledge, barrier factors in dietary management and needs of nutritional management program for women with Gestational Diabetes Mellitus (GDM). METHODS: A total of 100 women with GDM were recruited from secondary and tertiary hospitals in Seoul. The questionnaire composed of general characteristics, status of self-management, dietary habits, nutrition knowledge, barrier factors in dietary management, needs for nutrition information contents and nutritional management programs. Data were collected by a self-administered questionnaire. All data were statistically analyzed using student's t-test and chi-square test using SAS 9.3. RESULTS: About 35% of the subjects reported that they practiced medical nutrition and exercise therapy for GDM control. The main sources of nutrition information were ‘internet (50.0%)’ and ‘expert advice (45.0%)’. More than 70% of the subjects experienced nutrition education. The mean score of nutrition knowledge was 7.5 point out of 10, and only about half of the subjects were reported to be correctly aware of some questions such as ‘the cause of ketosis’, ‘the goal of nutrition management for GDM’, ‘the importance of sugar restriction on breakfast’. The major obstructive factors in dietary management were ‘eating more than planned when dining out’, ‘finding the appropriate menu when dining out’. The preferred nutrition information contents in developing management program were ‘nutritional information of food’, ‘recommended food by major nutrients’, ‘the relationship between blood glucose and food’, ‘tips on menu selection at eating out’. The subjects reported that they need management program such as ‘example of menu by calorie prescription’, ‘recommended weight gain guide’, ‘meal recording and dietary assessment’, ‘expert recommendation’, ‘sharing know-how’. CONCLUSIONS: Based on the results of this study, it is necessary to develop a program that provide personalized information by identifying the individual characteristics of the subjects and expert feedback function through various information and nutrition information contents that can be used in real life.

Evaluation of Oral Health Promotion Program Connected with Hypertension and Diabetes Management Programs: Use of a Logical Model / 치위생과학회지

This study aimed to design and operate a complementary integrated health management program based on the connection between the hypertension and diabetes management programs and the oral health programs at a public health center. It also proposed to suggest the phased evaluation indicators. In this study, 48 adults registered in the hypertension and diabetes management program were selected from the Gangneung public health center. The clinic-specific programs were led by dental hygienists and operated for visitors twice every two weeks. The programs were designed based on the logical model, and indicators for evaluating the structure, process, and outcome were presented and applied to the input, process, output, and outcome. The evaluation indices consisted of quantitative and qualitative indicators, and the planning and operation, goal achievement, and effect of each program were assessed. The process evaluations were assessed by the appropriateness of the managers and the operating fidelity of the programs. Indicators for evaluating the outcomes were gingival bleeding, oral health knowledge, oral health awareness, and the satisfaction of the participant and the manager. The clinic-specific programs resulted in positive changes in the evaluated outcomes. The integrated health management of visitors to the hypertension and diabetes management program is important as the general and oral health has common risk factors. Furthermore, long-term operation and continuous monitoring of oral health programs are necessary to evaluate the common factors in chronic disease management.

A study on the Needs for Nutrition Management Program for Elderly Who use Welfare Facilities / 대한지역사회영양학회지

OBJECTIVES: This study was performed to investigate the nutritional status, health conditions, eating habits and experience and demand for nutrition.dietary management of senior citizens. And these data are formed foundation of development of nutrition.dietary management education program and contents in welfare facilities for the aged. METHODS: We visited 3 public health centers, 3 senior citizens centers, and 4 welfare centers in Seoul, Gyeonggi-do, Chungnam province, and Daejeon area and carried out interview by semi-structured questionnaire for senior citizens older than 65 years who use those facilities. RESULTS: The study included 17%, 30.7% and 52.3% of senior citizens from public health centers, seniorcitizen centers and and welfare centers, respectively. The age range of 43.9% of the population was 65-74 years and and 56.1% were older than 75 years. We observed that 83.2% of subjects took some medicines due to diseases that they have and 58.0% took prescription medicines for hypertension. The thing that they considered the most when selecting food was 'the taste'(p<0.05). Regarding the level of practice to keep the dietary life, they answered more than 'average' for most of items but answered less than 'average' for lot of salt intake, drinking, exercise. For the experience of nutritionddietary life education, only 19.8% answered 'Yes' and the service for nutritionddietary life management showed the highest score in the demand for 'provide nutritious food'. For the size of consulting group for nutrition/dietary life education, the public health center and welfare center preferred a larger group size but the senior citizens center preferred a smaller group. With regard to who will carry out the consulting, the demand for dietitian was the highest and the operation type showed the high demand in the order of consulting, education. The contents that they want to have consultation in nutritionddietary life education were diet therapy for diseases and the ordinary diet therapy for health. CONCLUSIONS: This study suggested the management of nutritionddietry life necessitates qualitative measures according to the different types of welfare facilities. For these, it is in need of development of counseling and education program included therapy for disease. Above all, the policy to secure dietitian of welfare facilities for the aged to perform these should be achived.

Development of the evaluation tool for the food safety and nutrition management education projects targeting the middle class elderly: Application of the balanced score card and the structure-process-outcome concept / 한국영양학회지

PURPOSE: The aim of this study is to develop an evaluation tool for operation of food safety and nutrition education projects for middle class elderly using the concept of the balanced score card. METHODS: After the draft of the evaluation tool for the elderly training projects was completed, it was revised into the questionnaire and the validity of the indicators was tested by the Delphi group. The validity of the indicators was rated using a 5-point scale. The Delphi group consisted of 26 experts in the education sector, 16 government officials, and 24 professionals of the related area in communities. The first round test was conducted from July 9 to July 17, 2012, and 45 persons responded. The second round test was conducted from July 18 to July 25 and 32 persons responded. RESULTS: The indicators, which were answered by more than 75 percent of the experts as 'agree' (4 points), 'strongly agree' (5 point) were included as the final indicators for the evaluation tool: 28 items out of 36 in outcome perspectives, 9 items out of 12 in process perspectives, and 17 out of 20 items in structure perspectives. The score was allocated as 50 points for outcome indicators, 20 points for process indicators, and 30 points for structure indicators. CONCLUSION: Completion of the evaluation tool is a prerequisite to determine whether the program is effectively implemented. The monitoring tool developed in the study could be applied for identification of the most optimal delivery path for the food safety and nutrition education program, for the spread of the food safety and nutrition education program for middle class elderly.

Influencia de los factores psicosociales sobre el estado clínico de pacientes con insuficiencia cardiaca crónica manejados en una unidad multidisciplinaria / Influence of psychosocial factors on the clinical status of chronic heart failure patients, managed in a multidisciplinary unit

Introducción: los factores psicosociales han mostrado influenciar el estado clínico de pacientes con insuficiencia cardiaca (IC) crónica, particularmente en aquellos pacientes dependientes con alteración del estado mental o déficit del soporte social, en Colombia pocos estudios han sido conducidos para describir la influencia de factores psicosociales y otros factores clínicos relacionados con la enfermedad; por lo cual se realizó la siguiente pregunta de investigación: ¿Cuál es el diagnóstico psicosocial de una cohorte de pacientes del Programa de falla cardiaca y su correlación entre sí y con los parámetros clínicos medidos por Clase funcional, NT-ProBNP y fracción de eyección del ventrículo izquierdo (FEVI%)?. Conclusiones: en pacientes con insuficiencia cardiaca crónica, los factores psicosociales se relacionan con el estado clínico y factores pronóstico, en esta cohorte de pacientes se demuestra la relación de estado afectivo con los niveles de NT pro-BNP y una relación directa del deterioro de la calidad de vida en relación con el NT pro-BNP y la FEVI. La evaluación de la función psicosocial a través de escalas validadas debe ser fortalecida en el escenario de las unidades de insuficiencia cardiaca, con el fin de identificar oportunamente estos pacientes e implementar intervenciones multidisciplinarias que mejoren su pronóstico.

Background: Psychosocial factors have been shown its influence on the clinical status of patients with chronic heart failure (HF), particularly in patients with altered mental status, dependent, or with social support deficit, in Colombia, few studies have been conducted to describe the influence of Psychosocial factors and clinical characteristics associated with HF, which was carried by the following research question: ¿What is the psychosocial diagnosis in a cohort of patients managed in a heart failure program and its correlation with clinical parameters measured by functional class, NT-proBNP and Left Ventricular Ejection Fraction %?. Conclusions: In patients with chronic heart failure, psychosocial factors are related to clinical and prognostic factors, in our cohort we demonstrate the relation between affective state and NT-proBNP levels and a direct relation between quality of life and NYHA functional class. Evaluation of psychosocial function through validated scales , should be strength in the setting of Heart Failure Units, in order to identify social high risk patients and implement multidisciplinary interventions to improve their prognosis.

Cultivares, espaçamento entrelinhas e programas de aplicação de fungicidas no controle de Phakopsora pachyrhizi Sidow em soja / Cultivars, row spacing and fungicide application programs on Phakopsora pachyrhizi Sydow control in soybean

Com este trabalho, buscou-se avaliar a resposta de cultivares de soja, em duas safras, submetidas a diferentes espaçamentos entrelinhas e programas de controle sob pressão natural de Phakopsora pachyrhizi Sidow. Nas safras 07/08 e 08/09, os espaçamentos entrelinhas de 40, 50 e 60cm representavam as parcelas principais, as cultivares 'A 8000 RG' e 'A 6001 RG', as subparcelas e os programas de controle, as subsubparcelas. A redução do espaçamento entrelinhas permitiu melhores condições para o estabelecimento e progresso da ferrugem asiática para as duas cultivares e menor eficácia de controle. A melhor resposta de controle foi verificada com a utilização do programa após uma aplicação no estádio de desenvolvimento R1 e uma segunda aplicação 25 dias após a primeira. O espaçamento de 60cm entrelinhas proporcionou menores valores de doença acumulada e maior produtividade.

This study aimed to assess in two seasons, the response of soybean cultivars subjected to different row spacings and control programs under Phakopsora pachyrhizi Sidow natural pressure. The research was carried out at the seasons 07/08 and 08/09. The main plots were composed of the row spacings of 40, 50 and 60cm and the split plots corresponded to the cultivars A 8000 RG and A 6001 RG. The control programs were the split split plots.The reduction of row spacing allowed more conditions for the rust establishment and progress for both cultivars and less effective control. The best control response was verified using the program with an application in R1 and a second application, 25 days after the first one. The row spacing of 60cm gave lower AUDPC values and higher productivity.

TRENDS IN CLINICAL ENGINEERING PRACTICES

Appropriate deployment of technological tools contributes to improvement in the quality of healthcare delivered, the containment of cost, and better access to healthcare systems. Hospitals have been allocating significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new biomedical technology while asked to manage existing inventory for which they are not well prepared. To effectively manage their investments, hospitals are developing medical technology management programs that need expertise and planning methodology for safe and efficient deployment of healthcare technological tools. Clinical engineers are practitioners that can lead such programs and deliver technological solutions based on carefully determined needs and specified set of organization objectives and abilities. The successful practice of clinical engineering is dependent on the ability of these practitioners to transfer knowledge from the engineering and life sciences to the support of clinical applications. As rapid changes in the complexity and variety of technological tools and in the measurement of patient care outcomes taking place, it is best to facilitate transfer of such knowledge having well defined body of knowledge. This can be accomplished only when the goals of the profession are clearly described and uniformly accepted accommodating profession vision and commitment. Such a commitment must include the promotion of safe and effective application of science and technology in patient care and on the acceptance of professional accountability demonstratable by the achievement of competency recognition by national professional certification program. To be ready, clinical engineers must participate in continuing education activities and maintain wide level of expertise, demonstrate ability for leading and effectively executing complex projects and functions, and be accountable for maintaining safe technological tools/systems used in the patient environment. As systems complexity and integration continues to increase, now is the time to demonstrate that the required competencies do contribute to desired outcomes.

La adecuada implementación y aplicación de herramientas tecnológicas contribuye al mejoramiento de la calidad en la prestación de los servicios de salud, la minimización de los costos de dichos servicios, y el aumento de la accesibilidad al sistema hospitalario. En las últimas décadas los hospitales han venido asignando una considerable porción de sus recursos al cuidado y administración de sus bienes de capital; enfrentan continuamente la necesidad de adquirir nuevas tecnologías biomédicas al tiempo que deben administrar la existente, situación para la que no están bien preparados. Con el fin de orientar eficientemente sus inversiones, los hospitales han venido desarrollando programas de administración de tecnología médica que requieren expertos en el tema y la aplicación de metodologías específicas para un aprovechamiento seguro y eficiente de estas herramientas en el sector salud. Los ingenieros clínicos son quienes pueden liderar estos programas al proveer soluciones tecnológicas basadas en las necesidades prioritarias, cuidadosamente establecidas, y en los objetivos organizacionales específicos. El éxito en la práctica de la ingeniería clínica radica en la habilidad de estos profesionales de transferir los conocimientos del campo de la ingeniería y de las ciencias de la salud al entorno hospitalario para servir de soporte en las aplicaciones médicas. A medida que se dan grandes y rápidos cambios en la complejidad y variedad de las herramientas tecnológicas disponibles y en las formas de evaluar el cuidado que se le brinda a los pacientes, la mejor forma de transferir dichos desarrollos es mediante un completo conocimiento del tema. Esto se puede lograr sólo cuando los objetivos de la profesión han sido claramente definidos y son coherentes con el compromiso y la visión profesional. Tal compromiso debe incluir la promoción del uso seguro y eficaz de la ciencia y la tecnología al servicio del cuidado de los pacientes y la aceptación de la necesidad de demostrar sus capacidades como ingeniero clínico al adquirir el reconocimiento de sus competencias profesionales mediante el programa de certificación profesional nacional. Para estar preparados para estos desafíos los ingenieros clínicos deben participar en actividades de educación continua, mantener su pericia y habilidades profesionales, demostrar capacidad para liderar y ejecutar eficientemente proyectos y funciones complejas, y velar por el seguro mantenimiento de las herramientas y sistemas tecnológicos utilizados en el sector salud. A medida que aumenta la integración y la complejidad de los sistemas, es el momento de demostrar que las competencias de los ingenieros clínicos realmente contribuyen al cumplimiento de las metas establecidas.

The Effects of a Stress Management Program on Job Stress in a Hotel Culinary Staff

PURPOSE: This study was conducted to investigate the effects of a stress management program on Job Stress in culinary staff at a Hotel. METHOD: This was a quasi-experimental study using non-equivalent control group pretest-posttest design. The subjects of this study were 52 culinary staff members(head culinary, first culinary) working at a S hotel.(25 in the experimental group, 27 in the control group) The experimental group was provided with an individual counseling program for 12 weeks and 30 min/week. The control group was provided with booklets. Data were analyzed with SAS Program using repeated measures ANOVA. RESULTS: The stress management program was effective to improve job stressors and especially to relax interpersonal conflict among the sub-factors of job stress based on the results mentioned above. CONCLUSION: This program was effective in reducing job stress. However, further studies are required to measure persistent and long-term effects through the application of the program, which is specifically designed for reduce to job stress, for over 12 weeks.

Effect of Short-term Obesity Management Program for Local Community Residents

BACKGROUND: The incidence of obesity is acutely increasing resulting in increased mortality rate and medical expenses among Koreans. But it is rare to find effective obesity management program, that are readily accessible by general local community residents. This study was aimed to develop and evaluate an effective and specialized obesity management program utilizing the local public health institutes. METHODS: One hundred forty nine obese adults residing in Kwangju were enrolled in a tentative, 12-week scheduled obesity management program from August 2006 to October 2006. The program constituted of weekly education and practice by specialists, and exercise for more than an hour for 5 days a week. The effectiveness of the program was evaluated according to the change of body weight, body component, blood pressure, and serum lipid concentration. After the program was completed, each participant was surveyed on the degree of satisfaction and lifestyle changes. RESULTS: Ninety participants (60.4%) completed the program to the end. The average decrement of body weight after the program was 1.9+/-1.5 kg. Eleven participants (12.2%) lost more than 5% of the initial body weight. The waist circumference and average blood pressure significantly decreased among the group who lost more than 5% of the initial body weight. The total cholesterol and triglycerides also slightly decreased among this group. Overall 87.3% of the participants were satisfied with the results of the program. The lifestyle of the participants had also changed by the program. CONCLUSION: The authors expect that establishing easily- approachable obesity management program in local public health institutes will make a great contribution to the maintenance of proper body weight and decrement of cardiovascular diseases among local community residents.

The Effects of a Self-Management Program on Successful Aging

PURPOSE: The purpose of this study was to gain knowledge of successful aging for the Korean elderly and to identify the effects of an intervention program on the change of the knowledge. METHOD: Data were collected from 134 elders from 3 schools for the elderly in H City. The Successful Aging Scale was used to collect data and modified CDSMP was applied as the intervention. Descriptive statistics, t-test, ANOVA and ANCOVA were used. RESULTS: The total score of the knowledge of successful aging among the elderly cohort was 2.44 out of 3, and the scores of the factors making up old age were 2.66 for the success of children, 2.63 for self-control, 2.56 for self-efficacy, and 2.05 for happy marriage. Life satisfaction from the success of children and self-control were strongly correlated(r=0.7036, p=0.000). CONCLUSION: The self-management program brought positive changes to the knowledge of successful aging through the self-control parameter, and although it could not change the degree of knowledge of the overall successful aging among the elderly cohort, the program represents the first Korean nursing intervention focused on self-management techniques needed for successful aging.

Effect of a Breastfeeding Management Program on Breastfeeding Duration / 여성건강간호학회지

PURPOSE: The purpose of this study was to measure the effects of a breastfeeding management program for promotion of breastfeeding. METHOD: The study design was a non-equivalent control group pre-post test. The study subjects were pregnant women receiving a breastfeeding education class in one hospital in Ilsan. The total number of study subjects was 153 pregnant women, namely 75 mothers in the experimental group and 78 in the control group. Data was collected between June and November, 2006. A breastfeeding management program was provided to the experimental group while admitted for delivery, and in weeks 2, 4, 8, 12, 16, 20, and 24 of the postpartum period. The rates of breastfeeding were measured in weeks 2, 4, 8, 12, 16, 20, and 24 of the postpartum period. RESULT: There were significant differences in the scores of rate of breastfeeding between the two groups(all cases), which were 93.1 in the experimental group and 85.8 in the control group at week 4; 88.1 vs 71.8 at week 8; 83.4 vs 56.7 at week 12; 71.4 vs 53.9 at week 16; and 65.7 vs 48.4 at week 20 respectively. However, there were not significant differences in the scores of rate of breast-feeding between the two groups, which were 97.7 in the experimental group and 96.0 in the control group in the early postpartum period at week 2, and 59.6 vs 45.3 at week 24. Add to this, the study analyzed only people who had jobs. As a result, the scores of rate of breastfeeding were 94.8 in the experimental group which were significantly higher than 88.5 in the control group at week 4; 93.2 vs 73.3 at week 8; 89.6 vs 57.2 at week 12; and 75.0 vs 46.0 at week 20 respectively. However, there were not significant differences at week 2, week 16 and week 24. CONCLUSION: The results of this study suggest that a breastfeeding management program during the last trimester of the perinatal period and postpartum period may increase the duration of breastfeeding in postpartum clients who intend to breastfeed. This study supports the literature which found that prenatal education and postpartum support are important to the outcome of breastfeeding.