Factors Influencing on Problem Solving Ability of Nursing Students Experiencing Simulation Practice.

It has become important for nurses to implement self-leadership and exercise critical thinking in problem-solving to address the health issues of patients. This has led to a need for nursing education programs in which nursing students learn to embrace self-leadership and self-evaluation approaches to develop their skills. Within 260 nursing undergraduates with experience in simulation practice as study subjects, a self-reporting survey was conducted on self-leadership, goal commitment, critical thinking, and problem-solving skills. An analysis was conducted using the SPSS/WIN 21.0 program. t-test and ANOVA were conducted to validate the difference between problem-solving abilities. Multiple regression was conducted to examine the impact of these variables on problem-solving skills. The variables of religion, satisfaction with major, goal commitment, and critical thinking were found to have a significant impact on problem-solving abilities. The results were as follows: critical thinking (ß = 0.36, p < 0.05), goal commitment (ß = 0.28, p < 0.05), and explanatory power of 41%. To improve the nursing undergraduates' problem-solving abilities through simulation practice, there needs to be a method that supports them in setting goals with self-leadership and enhance goal commitment. The method also needs to support the development of their critical thinking and curiosity for questions deriving from experiencing diverse programs in order to deliver effective outcomes.

Development and Effects of Cognitive Behavior-Based Healing Programs Using Mobile Apps.

PURPOSE: There has been a recent surge in interest in mental health and how to improve individuals' health-related quality of life. Mental health management using mobile apps can be a useful intervention method. The development and application of verified and highly efficient apps for mental health and stress management are needed. We developed healing programs and verified their effectiveness based on apps designed to promote adult mental health. METHODS: We conducted a one-group pretest-posttest study in which 85 participants used the app for 12 weeks. We assessed its effects on participants' stress (perceived stress scale, effort-reward imbalance, and photoplethysmogram (PPG)), anxiety, depression, emotional labor, and well-being. RESULTS: The stress survey results post-intervention increased or stayed the same; however, the PPG results decreased (p = 0.002) after using the app. Depression (p = 0.043) and anxiety (p = 0.003) also decreased; however, emotional labor and well-being remained unchanged. The awareness of, knowledge of, and attitude toward mental health management all increased post-intervention. DISCUSSION: The developed mobile app was an efficient and highly accessible way to promote mental health. However, the app requires modification and supplementation for continual use. Additionally, ongoing research concerning the study, evaluation, and integration of mobile apps is required.

Impact of Mental Health on Wellness in Adult Workers.

Wellness in adult workers is intimately associated with better quality of life in individuals, as well as in the family, community, workplace, and country. This study aimed to examine the status of wellness in adult workers and to identify the factors that influence wellness. A descriptive survey was conducted with 260 adult workers. T- test and one-way ANOVA with post-hoc Scheffe test were used to analyze the data. Multiple regression analysis was performed on stress, depression, anxiety, well-being, self-efficacy, and perceived health status. The regression model for wellness in adult workers was significant (F = 42.21, p < 0.001), with an explanatory power of 0.558. Depression (ß = -0.306) was identified as the most influential factor for wellness in adult workers, followed by self-efficacy (ß = 0.280) and well-being (ß = 0.264). Depression, stress, and anxiety negatively influenced wellness, whereas self-efficacy, well-being, and perceived health status positively influenced wellness. Study findings suggest the need to develop intervention programs for workers that decrease stress, depression, and anxiety, and incorporate self-efficacy strategies.

Development and Application of a Program for Reinforcing Global Health Competencies in University Nursing Students.

Purpose: With globalization, the importance of global health is being stressed. Although nurses are indispensable healthcare professionals, programs to develop nurses with global health competencies and relevant studies are rare. Accordingly, this study was designed to develop a program to increase global health competencies and global leadership in nursing students and test its effect. Methods: A single group pre- and post-test study design was used. A 13-weeks program was developed and implemented with 204 students. Data were analyzed using paired t-test. The program to promote global health competencies was designed to improve nursing students' knowledge of global health, global leadership, global health competencies, critical thinking ability, and student-student partnership. Results: Global health competencies (t = -19.96, p < 0.001), self-assessed global leadership (t = -7.67, p < 0.001), and critical thinking ability (t = -7.67, p < 0.001) all significantly increased. Discussion: The study findings of increased global health competencies and global leadership in nursing students after participation in the program indicated ways in which global health competencies of nurses need to be developed. Therefore, the following aspects should be considered. First, nursing educators should understand the need and importance of global health education and accordingly, current nursing curriculums should be revised to include courses about global health. A systematic course of studies about global health should be developed and implemented based on discussions among experts and researchers. Second, as future health care professionals, nursing students should take an interest in global health problems and recognize various issues that need to be solved beyond borders between countries. To develop global health competencies, various efforts and systematic curriculum revisions are necessary.

Evaluation of the Effectiveness of Mobile App-Based Stress-Management Program: A Randomized Controlled Trial.

Improving mental healthcare using mobile apps might be an effective way to increase interest in mental health and respond to the demand for better psychological health. However, few studies have investigated the effectiveness of app-based stress-management programs. This study aimed to assess the efficacy of an app-based stress-management program. A non-equivalent comparison group pretest-posttest design was used. Participants were randomized into the experimental (n = 26) and control (n = 30) groups. The experimental group used an application developed for workers for four weeks. The results indicated that stress, emotional labor, self-efficacy, and well-being were significantly different in the experimental group, but the control group's average scores did not change significantly. On average, the Perceived Stress Scale scores decreased by 1.5 points (p = 0.035) and the Korean Occupational Stress Scale scores decreased by 0.87 points (p = 0.4). However, depression and anxiety were not significantly different. Emotional labor decreased by 0.16 points (p = 0.027), and well-being and self-efficacy mean scores increased by 0.492 (p = 0.005) and 0.162 (p = 0.025), respectively. These findings support the developed application's value for promoting mental health and healthy lifestyles. Further research and supplementation are needed for the application's sustainability.

Association between osteocalcin and metabolic syndrome in postmenopausal women.

OBJECTIVES: Undercarboxylated osteocalcin (ucOC) has been proved as a regulator of glucose and fat mass in an animal model. This study examined the association between osteocalcin and metabolic syndrome (MetS) in postmenopausal women. METHODS: We selected 135 postmenopausal women and determined anthropometric values [waist-hip ratio (WHR), visceral fat area (VFA), body fat mass (BFM), and skeletal muscle mass (SMM)], the lipid profile, fasting plasma glucose (FPG), insulin, high-sensitivity C-reactive protein (hs-CRP), homeostasis model assessment of insulin resistance (HOMA-IR), serum leptin and adiponectin level, and serum tOC and ucOC level. RESULTS: There were 52 postmenopausal women in the MetS group. After adjusting for age and years since menopause, ucOC was negatively correlated with WHR, VFA, BFM, triglyceride, fasting insulin, HOMA-IR, and serum leptin and was positively correlated with serum adiponectin. The odds ratio for MetS was significantly lower in the highest quartile than the lowest quartile after adjusting for age, years since menopause, and BMI. In multiple regression analysis, serum leptin and HOMA-IR were the most important predictors of the independent variables that affect serum ucOC. CONCLUSION: ucOC showed an inverse correlation with markers of insulin resistance, central obesity, and the presence of MetS in postmenopausal women and appears to protect against MetS. Further large-scale clinical and experimental studies are needed to clarify the potential of ucOC as a predictor of MetS in postmenopausal women.

Effect of helixor A on natural killer cell activity in endometriosis.

BACKGROUND AND AIM: NK cells are one of the major immune cells in endometriosis pathogenesis. While previous clinical studies have shown that helixor A to be an effective treatment for endometriosis, little is known about its mechanism of action, or its relationship with immune cells. The aim of this study is to investigate the effects of helixor A on Natural killer cell (NK cell) cytotoxicity in endometriosis MATERIALS AND METHODS: We performed an experimental study. Samples of peritoneal fluid were obtained from January 2011 to December 2011 from 50 women with endometriosis and 50 women with other benign ovarian cysts (control). Peritoneal fluid of normal control group and endometriosis group was collected during laparoscopy. Baseline cytotoxicity levels of NK cells were measured with the peritoneal fluid of control group and endometriosis group. Next, cytotoxicity of NK cells was evaluated before and after treatment with helixor A. NK-cell activity was determined based upon the expression of CD107a, as an activation marker. RESULTS: NK cells cytotoxicity was 79.38±2.13% in control cells, 75.55±2.89% in the control peritoneal fluid, 69.59±4.96% in endometriosis stage I/II endometriosis, and 63.88±5.75% in stage III/IV endometriosis. A significant difference in cytotoxicity was observed between the control cells and stage III/IV endometriosis, consistent with a significant decrease in the cytotoxicity of NK cells in advanced stages of endometriosis; these levels increased significantly after treatment with helixor A; 78.30% vs. 86.40% (p=0.003) in stage I/II endometriosis, and 73.67% vs. 84.54% (p=0.024) in stage III/IV. The percentage of cells expressing CD107a was increased significantly in each group after helixor A treatment; 0.59% vs. 1.10% (p=0.002) in stage I/II endometriosis, and 0.79% vs. 1.40% (p=0.014) in stage III/IV. CONCLUSIONS: Helixor A directly influenced NK-cell cytotoxicity through direct induction of CD107a expression. Our results open new role of helixor A as an imune modulation therapy, or in combination with hormonal agents, for the treatment of endometriosis.

Usefulness of CA125 in the differential diagnosis of uterine adenomyosis and myoma.

OBJECTIVES: To evaluate the usefulness of CA125 levels in the differential diagnosis of adenomyosis and myoma. This has been addressed by few, if any, previous studies. STUDY DESIGN: Preoperative serum CA125 levels were measured in 2149 women who were diagnosed at total hysterectomy as having adenomyosis, myoma, endometriosis, and/or normal pelvis. Their medical records were retrieved and reviewed. RESULTS: The mean serum CA125 level in the adenomyosis patients was significantly greater than that in the patients diagnosed with myoma (65.21±96.60 U/mL vs.12.86±14.23 U/mL, respectively; P<0.001). In the differential diagnosis of adenomyosis and myoma, the cut-off serum CA125 level with the highest accuracy (78.8%) and highest diagnostic value (61.2%) was 19 U/mL. Using this cut-off value, the negative predictive value was 69.5%, and the positive predictive value was 76.5%. These results are clearly superior to those of the empirical single cut-off value of 35 U/mL. Receiver operating characteristic curve analysis revealed the area under the curve for differentiating adenomyosis from myoma was 0.776, indicating good diagnostic performance. CONCLUSION: In the differential diagnosis of adenomyosis and myoma, cut-off values for CA125, particularly the cut-off value of 19 U/mL, provide improved diagnostic performance. Serum CA125 testing can be performed during the initial screening of women with possible adenomyosis to differentiate this condition from myoma, although the diagnostic accuracy of using CA125 testing alone is limited.

Association of the nipple-areola complexes with age, parity, and breastfeeding in Korean premenopausal women.

BACKGROUND: There is no standard method of measuring the nipple-areola complex or defining the normal range and the changes seen in this complex. Numerous factors are involved in the anthropometric characteristics of the nipple-areola complex. OBJECTIVE: The purpose of this study was to evaluate the anthropometric characteristics of the nipple-areola complex related to age, parity, and breastfeeding in 234 premenopausal Korean women (468 breasts). METHODS: This cross-sectional study was conducted from May 2011 to June 2012. Five parameters of both nipple-areola complexes were measured in volunteers who were placed in a supine position. The diameters of the nipple-areola complex and the nipple projection were measured using micrometer calipers. RESULTS: The size of the nipple-areola complex increased according to age (P < .05). The measurements of the right nipple and the vertical diameter of the right areola were larger than those of the left sides in all age groups. There were no differences in the horizontal areola diameter and nipple projection between the 2 sides. The left horizontal areola diameter in breastfeeding parous women was larger than that in the non-breastfeeding parous women group (P = .011). The nipple projection was associated with the duration of breastfeeding (especially more than 12 months). The percentage of women with retracted nipples was 11.2%. CONCLUSION: Our study may be helpful in understanding nipple-areola complex changes related to age, parity, and breastfeeding. These results should be evaluated with larger study cohorts and more longitudinal studies to better understand factors related to changes of the nipple-areola complex.

Comparison of the inhibitory effect of gonadotropin releasing hormone (GnRH) agonist, selective estrogen receptor modulator (SERM), antiprogesterone on myoma cell proliferation in vitro.

Uterine myomas are the most common gynecologic tumor in women of reproductive age. Treatment options of uterine myomas consist of surgical, medical and interventional therapy such as uterine artery embolization or myolysis. Given that it is the most common type of tumor in women of reproductive age, the treatment of uterine myomas must prioritize uterine conservation. There are several drugs for medical treatment of uterine myoma such as gonadotropin releasing hormone (GnRH) agonist, selective estrogen receptor modulator (SERM) and antiprogesterone. The objective of this study was to compare the effect of GnRH agonist, SERM, and antiprogesterone in the treatment of uterine myomas in vitro. The effect of drugs was evaluated through the cell viability assay in cultured leiomyoma cells, western blot analysis of proliferating cell nuclear antigen (PCNA), and BCL-2 protein expression. As a result, mifepristone single-treated group represents the most significant reduction in myoma cell viability and proliferation. When pretreated with leuprolide acetate, raloxifene shows more significant reduction in myoma cell viability and proliferation than mifepristone. This study suggests one of the possible mechanisms how medications act on uterine myoma, especially at the molecular level.

Pulmonary nodule registration in serial CT scans using global rib matching and nodule template matching.

We propose an automatic nodule registration method between baseline and follow-up chest CT scans. Initial alignment using the center of the lung volume corrects the gross translational mismatch, and rigid registration using coronal and sagittal maximum intensity projection images effectively refines the rigid motion of the lungs. Nodule correspondences are established by finding the most similar region in terms of density as well as the geometrical constraint. The proposed nodule registration method increased the nodule hit rate (the ratio of the number of successfully matched nodules to total nodule number) from 26% to 100%.

Mullerian inhibiting substance induces apoptosis of human endometrial stromal cells in endometriosis.

CONTEXT: Müllerian inhibiting substance (MIS) is produced in Sertoli cells of fetal testis and causes regression of müllerian ducts in male embryos. MIS also can induce the cell cycle arrest and apoptosis in müllerian duct-derived tumors in vivo and in vitro. OBJECTIVE: Our objective was to investigate the expression of MIS type II receptor (MISR II) and whether MIS can inhibit the proliferation and induce apoptosis in primary cultures of endometrial stromal cells (ESC) of endometriosis. DESIGN AND SETTINGS: In vitro experiments were performed in the university research laboratory. PARTICIPANTS: Tissue samples from 12 patients who had undergone evisceration for ovarian endometrial cysts were included in this study. INTERVENTIONS AND MAIN OUTCOME MEASURES: The expression of MISR II in ESC was investigated by immunohistochemistry. The cell viability and apoptosis in ESC treated with MIS was measured by methylthiazoletetrazolium assay and annexin V analysis. The expression of regulatory proteins in ESC treated with MIS was shown by Western blotting. RESULTS: ESC showed specific immunostaining for the MISR II. ESC treated with MIS exhibited 32% growth inhibition (P = 0.0001). The changes in cell cycle distribution after MIS exposure at 72 h demonstrated that S and G(2)M phases were decreased; G(0)G(1) and sub-G(0)G(1) phases were increased. ESC treated with MIS showed 13.72% annexin V-fluorescein isothiocyanate positivity. In the ESCs, which contain defective p16, MIS increased the expression of pocket proteins p107 and p130 and decreased E2F transcription factor 1. CONCLUSIONS: The results support a central role for MIS in endometriosis. Although the precise mechanism of MIS-mediated inhibition of ESC growth has not been fully defined, these data suggest that MIS has activity against ESC in vitro and may also be an effective targeted therapy for endometriosis.

Expression of Müllerian inhibiting substance type II receptor and antiproliferative effects of MIS on human cervical cancer.

This study aimed to analyze expression of Müllerian inhibiting substance type II receptor (MISRII) protein and mRNA in cervical neoplasia, to demonstrate the growth inhibition of cervical cancer cells by administration of highly purified recombinant human Müllerian inhibiting substance (MIS) and, furthermore, to evaluate the clinical significance of MIS as a biological modifier for MIS receptor expressing tumors. Reverse transcriptase polymerase chain reaction (RT-PCR) was used for MISRII mRNA expression, and in situ hybridization and immunohistochemistry were used to observe expression, location of MISRII mRNA and protein, respectively. To demonstrate the effect of MIS on the viability of cervical cancer cells, methyl thiazole tetrazolium (MTT) assay was performed. Flow cytometry was used to evaluate the cell cycle distribution after exposure to MIS in cervical cancer cells, and the annexin-V-FITC staining method was performed to demonstrate apoptosis by MIS in cervical cancer cells. Expression of MISRII protein and mRNA were observed in all normal cervical and cervical carcinoma tissues. There was no significant difference in expression of MISRII protein and MISRII mRNA between normal cervical and cervical carcinoma tissues. MTT assay showed negative correlation between MIS exposure time and the viability of cervical cells (P=0.008). The changes in cell cycle distribution after MIS exposure suggest that MIS plays an important role in inducing cellular apoptosis by causing arrest at the G1 phase and increasing cells at sub-G0G1 phase. Annexin-V-FITC staining methods showed that cellular apoptosis was, respectively, 10.44 and 12.89% after 24 and 48 h of MIS exposure in cervical carcinoma cells. There was a negative correlation between cellular survival and MIS exposure time. This study demonstrates that MISRII is present on normal cervical and cervical carcinoma tissues, and MIS shows receptor-mediated antiproliferative effect on cervical cells in vitro. These data suggest that MIS may be used as a biological modifier or therapeutic modulator on MISRII-expressing tumors in the future.

Association between obesity, metabolic risks and serum osteocalcin level in postmenopausal women.

BACKGROUND: Osteocalcin, a marker of bone formation, is also known as a regulator of glucose and fat mass. The purpose of this study was to determine the association between obesity, metabolic risks and serum osteocalcin in postmenopausal women. METHODS: We selected 214 postmenopausal women and determined serum osteocalcin, fasting plasma glucose (FPG), fasting insulin, high-sensitivity C-reactive protein (hs-CRP), the homeostasis model assessment of insulin resistance (HOMA-IR), lipid profile, and anthropometric values (body mass index [BMI], waist-to-hip ratio [WHR], body fat, and visceral fat area [VFA]). RESULTS: After adjustment for age and years since menopause, WHR and VFA were negatively correlated with serum osteocalcin, but BMI did not show a significant correlation. Serum osteocalcin was negatively correlated with fasting insulin and HOMA-IR, but FPG, lipid profile, and blood pressure did not show a significant correlation. Based on multiple regression analysis, age and HOMA-IR were the most important predictors of osteocalcin. CONCLUSION: Our study showed that serum osteocalcin has some significance as an indicator of metabolic risk, including abdominal obesity and insulin resistance. Bone as well as adipose tissue may be an active organ that regulates energy metabolism. A larger study will be needed to clarify the potential of osteocalcin as an indicator of cardiovascular disease.

Association between menopausal symptoms and metabolic syndrome in postmenopausal women.

PURPOSE: Menopausal symptoms are major concerns of postmenopausal women. Metabolic syndrome (MetS) is a risk factor for cardiovascular disease, and menopause is associated with an increased prevalence of MetS. The purpose of this study was to determine the association between menopausal symptoms and MetS in postmenopausal women. METHODS: We selected 183 women who attended St. Vincent Hospital of the Catholic University of Korea in 2008 and 2009 and divided them into two groups (with and without MetS). Menopausal status was assessed with the Menopause Rating Scale (MRS) questionnaire. The body mass index and waist-to-hip ratio were determined, and the serum fasting glucose, lipid profile, and blood pressure were measured in all participants. RESULTS: Of 183 postmenopausal women, 64 (35.0%) had MetS. A significant increase was observed in the total MRS score and the total somatic symptom subscale score in the MetS group (p = 0.021, p = 0.043, respectively). Vasomotor symptoms such as hot flashes and sweating occurred with higher frequency in the MetS group than in those without MetS (p = 0.034). High triglyceride levels and an increase of the number of components of MetS were associated with a higher total subscale score of somatic symptoms (p = 0.044, p = 0.039, respectively). CONCLUSIONS: These results showed that a higher total subscale score and a higher frequency of somatic symptoms such as hot flashes and sweating were present in the MetS group. Larger scale studies are needed to clarify the association between other menopausal symptoms and MetS in postmenopausal women.

Comparison of selective uterine artery double ligation at the isthmic level of uterus and bipolar uterine artery coagulation in total laparoscopic hysterectomy.

In this article, we would like to compare the clinical characteristics and effectiveness of selective uterine artery double ligation and bipolar uterine artery coagulation in total laparoscopic hysterectomy (TLH) retrospectively. TLH was performed on 72 patients with selective uterine artery double ligation and on 312 patients with uterine artery bipolar coagulation in tertiary university hospital from January 2004 through January 2006. Both groups were similar with respect to age, body mass index, parities, rate of menopause and uterine weight. The mean transfusion, postoperative hospital stay and drain insertion in the selective uterine artery double ligation group were significantly lower than those in the bipolar uterine artery coagulation group in TLH, respectively (p < .05). There were no differences in the hemoglobin, hematocrite change, additional operations, operation time, rate of complication between the two kinds of operation (p > .05). In conclusion, selective uterine artery double ligation in TLH showed lower transfusion rate, less hospitalization and less discomfort due to drain than bipolar uterine artery coagulation. Also, it did not take a longer time for operation and thus provides a feasible and secure method to manage uterine vessels at the level of uterine isthmus inside of the broad ligament.

Antioxidant effect of estrogen on bovine aortic endothelial cells.

OBJECTIVE: This study discussed the role of estrogen as an antioxidant in the damage of vascular endothelial cells. DESIGN: We treated bovine aortic endothelial cells (bAEC) either with 1mM of H(2)O(2) alone or with 1 microM of 17beta-estradiol (E(2)) for 24h followed by 1mM of H(2)O(2) for 3h. The cell survival was evaluated by MTT assay, cellular apoptosis by fluorescence activated cell sorter (FACS) and Hoechst 33342 staining, oxidative stress by intracellular reactive oxygen species (ROS) and apoptosis after oxidative stress by western blotting for phospho-p38, p38, and Bcl-2. RESULTS: MTT assay showed that bAEC viability was reduced to 55.7+/-3.0% and 39.1+/-3.7% after 30 and 60 min of H(2)O(2) treatment, respectively. E(2) and H(2)O(2) treated cells did not show significant decrease in the cell survival. Similarly the FACS analysis and Hoechst 33342 stain showed that the latter decreased cellular apoptosis induced by H(2)O(2). Intracellular ROS increased by 181.6+/-68.9% in the former and by 37.0+/-3.9% in the latter (P<0.05). The expression of phospho-p38 mitogen-activated protein kinase (MAPK) was higher in the latter. CONCLUSIONS: E(2) mediates antioxidant effects on the oxidative stress induced by H(2)O(2). This antioxidant effect on bAEC may elucidate the scientific basis of hormone therapy for maintaining cardiovascular integrity in postmenopausal women.

Antioxidant effects of equol on bovine aortic endothelial cells.

This study is to examine the effects of equol on the H(2)O(2)-induced death of bovine aortic endothelial cells (bAECs) and the mechanism of its protective effects. MTT[3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide] assay showed that in the control group, cell survival rate decreased significantly, each in proportion to the duration of the H(2)O(2) stimulation (P<0.05), but, in the equol-pretreated group, such decrease was not statistically significant. After Hoechst 33342 staining, in the equol-pretreated group the number of cells with apoptotic morphology decreased significantly. Equol pretreatment effectively inhibited the H(2)O(2)-induced cell death by the reduction of intracellular ROS production (P<0.05). Incubation of bAECs with equol increased the expression of phospho-p38 MAPK and Bcl-2 after the H(2)O(2) exposure compared with their expression without the equol pretreatment. Furthermore, SB203580 inhibited phospho-p38 MAPK expression and increased apoptotic cell death. This study proves equol has a significant antioxidant effect on the bAECs that were exposed to H(2)O(2).