Valorization of fruit and vegetable byproducts for the beta-glucan production from Euglena gracilis.

Five fruit and vegetable byproducts were evaluated as carbon sources and media for beta-glucan production from Euglena gracilis. Orange peel showed the highest beta-glucan concentration (6.5 g/L) and productivity (1.9 g/L/day) when used as a medium. However, when employed as carbon sources, apple pomace showed the highest beta-glucan concentration (10.6 g/L) and productivity (3.5 g/L/day). The appropriate chemical oxygen demand/nitrogen ratio (71.1) and favorable carbon sources of apple contributed to beta-glucan production. Increasing sugar concentrations in apple pomace and orange peel from 10 to 30 g/L raised the beta-glucan concentration to 11.6 g/L. Using apple pomace and orange peel individually proved more effective than mixing them for beta-glucan production. Therefore, apple as a carbon source is the most effective fruit and vegetables byproduct for beta-glucan production. This is expected to reduce the cost of E. gracilis cultivation on a large-scale and contribute to the circular economy.

A Caring Program for Health Promotion among Women Who Have Experienced Trauma: A Quasi-Experimental Pilot Study.

PURPOSE: Women are more vulnerable to post-traumatic stress (PTS) than men, causing several health problems. Nurses should understand and work with women who have experienced trauma and provide interventions to promote their physical, social, and mental health. METHODS: This quasi-experimental pilot study used a one-group pre-test/post-test design. Data were collected from 14 women recruited between December 2019 and May 2020 from a self-sufficiency support center in South Korea for sexually-exploited women who had experienced trauma. The program consisted of six one-on-one intervention sessions per week for six weeks. Each session averaged 60~120 minutes. Participants were assessed at pre-test, post-test, and one-month follow-up. Changes in outcome variables over time were analyzed using the Wilcoxon signed-rank and Friedman tests. RESULTS: The caring program for health promotion was divided into six sessions: understanding the self, sharing traumatic events and negative emotions, reframing the meaning of traumatic events, identifying thoughts and physical and emotional responses, developing health promotion activities, and maintaining a positive attitude during the process of change. As a result of the caring program, PTS (F = 36.33, p < .001), depression (F = 24.45, p < .001), health-promoting behaviors (F = 7.06, p =.004), and self-esteem (F = 19.74, p < .001) among the participants differed significantly at pre-test, post-test, and follow-up. CONCLUSION: This study provides foundational information for the implementation of a theory-driven program by nurses in clinical and community settings to provide comprehensive care for women who have experienced trauma.

Evaluation of Internet-Based Training in Trauma Care for Nurses in Mental Health Welfare Centers: A Cluster Randomized Controlled Trial.

OBJECTIVE: This study evaluates the efficacy of Internet-Based Training in Trauma Care for Nurses (IBTTCN) to improve nurses' trauma intervention self-efficacy, professional quality of life, and attitudes and knowledge about post-traumatic stress disorder. METHODS: Forty-one nurses participated from May to July 2021. The assessment points were at baseline (T1), immediately after program completion (4 weeks; T2), and 1 month after T2 (T3). Data were analyzed using repeated-measures analysis and generalized estimating equations. RESULTS: In the intervention group, trauma intervention self-efficacy increased significantly after the IBTTCN, and the effect of such self-efficacy over time was significant. CONCLUSIONS: The IBTTCN improved nurses' trauma intervention self-efficacy.

Development and effects of an internet-based family resilience-promoting program for parents of children with cancer: A randomized controlled trial.

PURPOSE: The diagnosis of cancer in children can negatively impact their parents, owing to the complex treatment processes. Families with high levels of resilience can overcome these difficulties and thus perform higher family functions. We aimed to develop an internet-based family resilience-promoting program for parents of children with cancer and evaluate its effect on the levels of family resilience, depression, and family function. METHODS: This prospective, parallel-group, randomized-controlled study that was conducted at Yonsei Cancer Center from June to October 2021 included 41 parents of children with cancer. In total, four sessions of the internet-based family resilience-promoting program, led by a nurse, were conducted individually for parents. Levels of family resilience, depression, and family function were measured before, immediately after, and 4 weeks after the program. The data were analyzed using the linear mixed-effect model, and program satisfaction was evaluated through an internet-based questionnaire and interview. RESULTS: The experimental group (the family resilience-promoting program participants) differed more significantly from the control group in the level of change in family resilience (ß = 13.214, p = 0.003, effect size = 0.374) and family function (ß = 1.256, p = 0.018, effect size = 0.394). However, there was no significant difference between the groups in the level of depression (ß = 2.133, p = 0.187, effect size = 0.416). All the program participants showed a high program satisfaction score of 4.75 out of 5.00 points overall. CONCLUSIONS: The applicability of the internet-based family resilience-promoting program as an appropriate nursing intervention was verified. Its application can help the families of children with cancer adapt to the stressful situation of their children's cancer diagnosis and treatment.

Development and evaluation of an online mental health program for traumatized female college students: A randomized controlled trial.

This study developed and evaluated an online mental health program for female college students who experienced trauma, based on Roy's Adaptation Model. A randomized controlled trial was adopted. Participants completed a survey on trauma and post-traumatic stress symptoms. Data from experimental and control groups (n = 16) were collected over two months. The program reduced post-traumatic stress and depression symptoms and improved functional health and adjustment. This effect was sustained in experimental group participants for one month post-program. The findings revealed the effectiveness of Internet mental healthcare for female students and the crucial role nurses play in it.

Standard-Intensity Versus Low-Intensity Anticoagulation with Warfarin in Asian Patients with Atrial Fibrillation: A Multi-Center, Randomized Controlled Trial.

Anticoagulation with warfarin in Asian patients with atrial fibrillation (AF) often has been decreased as an international normalized ratio (INR) of prothrombin time 1.6-2.6 due to fear of bleeding, although universal criteria recommend an INR of 2.0-3.0. In this randomized, open-label trial, low-intensity anticoagulation (INR 1.6-2.6) was compared with standard-intensity anticoagulation (INR 2.0-3.0) with warfarin. A total 616 patients with AF and at least 1 risk factor for stroke were randomized to low-intensity anticoagulation (n = 308) and standard-intensity anticoagulation (n = 308) groups. The intention-to-treat analysis was performed to determine differences. The baseline characteristics of the two groups were comparable. New-onset stroke occurred in 2 patients (0.44% per year) in the low-intensity group and 5 patients (1.05% per year) in the standard-intensity group (HR 0.42, 95% CI 0.08-2.15). Major bleeding occurred in 4 patients (0.89% per year) in the low-intensity group and 5 patients (1.06% per year) in the standard-intensity group (HR 0.84, 95% CI 0.22-3.11). The rate of the net clinical outcome (composite of stroke, systemic embolism, major bleeding, and death) was 1.33% per year in the low-intensity group compared with 2.12% per year in the standard-intensity group (HR 0.63, 95% CI 0.23-1.72). In Asian patients with AF, clinical outcomes were not different between low-intensity and standard-intensity anticoagulation with warfarin.

Biofuel production from Euglena: Current status and techno-economic perspectives.

Sustainable aviation fuels (SAFs) can contribute reduce greenhouse gas emissions compared to conventional fuel. With the increasing SAFs demand, various generations of resources have been shifted from the 1st generation (oil crops), the 2nd generation (agricultural waste), to the 3rd generation (microalgae). Microalgae are the most suitable feedstock for jet biofuel production than other resources because of their productivity and capability to capture carbon dioxide. However, microalgae-based biofuel has a limitation of high freezing point. Recently, a jet biofuel derived from Euglena wax ester has been paying attention due to its low freezing point. Challenges still remain to enhance production yields in both upstream and downstream processes. Studies on downstream processes as well as techno-economic analysis on biofuel production using Euglena are highly limited to date. Economic aspects for the biofuel production will be ensured via valorization of industrial byproducts such as food wastes.

Developing an app-based self-management program for people living with HIV: a randomized controlled pilot study during the COVID-19 pandemic.

People living with human immunodeficiency virus (PLWH) in Korea demonstrate insufficient self-management behaviors. Especially during pandemics such as COVID-19, technology-based self-management programs are needed to overcome time and space limitations. The purpose of this study was to evaluate the effects of a self-management program using a mobile app (Health Manager) on self-management outcomes among PLWH in Korea. A randomized controlled pilot trial was performed and participants were enrolled in the infectious outpatient clinic of a single hospital. The intervention group used the mobile app for 4 weeks, while the control group received self-management education materials in a portable document format. The online self-report questionnaire assessed primary outcomes including self-efficacy for self-management, self-management behaviors, and medication adherence, and secondary outcomes including perceived health status, depression, and perceived stigma. Thirty-three participants were randomly assigned to the intervention (n = 17) or the control group (n = 16). In the intention-to-treat analysis, self-efficacy for self-management and self-management behaviors increased, while perceived stigma decreased. The app-based self-management program could be considered a helpful strategy to improve self-management outcomes among PLWH and reduce their perceived stigma during the pandemic. Further studies with larger samples and longer follow-ups are needed.Trial registration: Clinical Research Information Service, KCT0004696 [04/02/2020].

Effects of a Social and Emotional Competence Enhancement Program for Adolescents Who Bully: A Quasi-Experimental Design.

BACKGROUND: The purpose of this study was to develop a social and emotional competence enhancement (SECE) program as an intervention for adolescents who bully, and to investigate its effects on school bullying behavior and mental health. METHODS: A pre-posttest, 1-month follow-up nonequivalent control group quasi-experimental design was used. In total, 71 school bullies were included in the analysis. RESULTS: The effects of this program were significant with regard to group-by-time interaction effects on social competence, emotional regulation, empathy, and school bullying behavior at the 1-month follow-up. CONCLUSIONS: The results indicate that the SECE program was effective at reducing school bullying behavior in adolescents who bully. School and community-based mental health professionals can provide feasible interventions that can be used in the short term to reduce school bullying behavior in adolescents who bully.

Microalgal transformation of food processing byproducts into functional food ingredients.

Large amounts of food processing byproducts (FPBs) are generated from food manufacturing industries, the second-largest portion of food waste generation. FPBs may require additional cost for post-treatment otherwise cause environmental contamination. Valorization of FPBs into food ingredients by microalgae cultivation can save a high cost for organic carbon sources and nutrients from medium cost. This study reviews FPBs generation categorized by industry and traditional disposal. In contrast with the low-value production, FPBs utilization as the nutrient-abundant medium for microalgae can lead to high-value production. Due to the complex composition in FPBs, various pretreatment methods have been applied to extract the desired compounds and medium preparation. Using the FPB-based medium resulted in cost reduction and a productivity enhancement in previous literature. Although there are still challenges to overcome to achieve economic viability and environmental sustainability, the microalgal transformation of FPBs is attractive for functional food ingredients production.

Developing an integrated curriculum for patient safety in an undergraduate nursing program: a case study.

BACKGROUND: Nursing students' practical training should begin when students can apply core knowledge, skills, and attitudes related to patient safety. This necessitates an integrated curriculum in nursing education that links practice to the theory concerning patient safety to enhance patient safety competencies and quality in nursing care. This study aimed to develop an integrated curriculum that incorporates patient safety factors in the existing curriculum to increase patient safety competencies in nursing students. METHOD: A case study approach was adopted to explain the development processes of a new curriculum integrating patient safety in the existing outcome-based curriculum of a nursing college. Based on the existing outcome-based curriculum of a nursing college, a four-step process was performed to integrate patient safety component, including quality improvement, into the curriculum: 1) literature review, 2) analysis of course syllabus, 3) selection of courses related to patient safety topics, and 4) development of evaluation tool. RESULTS: The integrated patient safety curriculum was based on six topics: patient safety principles, teamwork, communication, patient engagement, risk management and, quality improvement, and International Patient Safety Goals. Based on the characteristics of the course according to the level of students in each year, the curriculum was integrated to address patient safety topics in seven courses (four theoretical and three practical). A Patient safety Competency self-assessment checklist was developed for students to naturally acquire patient safety competencies in clinical settings. CONCLUSIONS: This study demonstrated that patient safety topics should be addressed in both theoretical and practical settings across the entire nursing curriculum per the continuity and sequence of education principles.

Isolation and Characterization of Euglena gracilis-Associated Bacteria, Enterobacter sp. CA3 and Emticicia sp. CN5, Capable of Promoting the Growth and Paramylon Production of E. gracilis under Mixotrophic Cultivation.

Euglena gracilis produces paramylon, which is a feedstock for high-value functional foods and nutritional supplements. The enhancement of paramylon productivity is a critical challenge. Microalgae growth-promoting bacteria (MGPB) can improve microalgal productivity; however, the MGPB for E. gracilis remain unclear. This study isolated bacteria capable of enhancing E. gracilis growth and paramylon production under mixotrophic conditions. Enterobacter sp. CA3 and Emticicia sp. CN5 were isolated from E. gracilis grown with sewage-effluent bacteria under mixotrophic conditions at pH 4.5 or 7.5, respectively. In a 7-day E. gracilis mixotrophic culture with glucose, CA3 increased E. gracilis biomass and paramylon production 1.8-fold and 3.5-fold, respectively (at pH 4.5), or 1.9-fold and 3.5-fold, respectively (at pH 7.5). CN5 increased E. gracilis biomass and paramylon production 2.0-fold and 4.1-fold, respectively (at pH 7.5). However, the strains did not show such effects on E. gracilis under autotrophic conditions without glucose. The results suggest that CA3 and CN5 promoted both E. gracilis growth and paramylon production under mixotrophic conditions with glucose at pH 4.5 and 7.5 (CA3) or pH 7.5 (CN5). This study also provides an isolation method for E. gracilis MGPB that enables the construction of an effective E. gracilis-MGPB-association system for increasing the paramylon yield of E. gracilis.

Developing an Internet-Based Trauma Recovery Nursing Intervention Based on Swanson's Theory of Caring for Trauma Recovery.

This study aimed to develop an Internet-based psychiatric nursing intervention, based on Swanson's theory of caring, that could alleviate post-traumatic stress symptoms and improve the health functioning of adults who had experienced trauma. To evaluate the appropriateness and understanding of the program content, expert advice and content validity were examined using the content validity index. To analyze the participants' responses and evaluate the appropriateness of conducting Internet-based programs, an online intervention program was implemented with five nurses between February and April 2020. The trauma recovery nursing intervention program was for adults who had experienced trauma and consisted of eight sessions, each lasting 30 min. It included a spoken audio track that was accompanied by visual prompts to provide knowledge on traumatic stress and introduce trauma recovery methods. Its online format made it convenient and widely accessible, and allowed for a low-intensity, cost-effective educational program. The program focused on providing self-help guidelines for clients to develop their mental and physical well-being. The results provide evidence that mental health nurses could develop and implement online programs to care for people who have experienced trauma. Such programs could provide trauma recovery for marginalized people unable to otherwise receive help.

Effects of social support on mental health outcomes in disasters: A cross-sectional study.

This study examined the mediating effects of social support on the association between disaster distress and mental health outcomes. We analyzed the data of 1006 participants with either direct or indirect exposure to one or more disasters. Disaster distress, social support, depression, and anxiety were significantly correlated. Multiple regression and mediation analyses with bootstrapping showed that social support was a partial mediator between disaster distress and depression, and between disaster distress and trait anxiety. It was a complete mediator between disaster distress and state anxiety. The results suggest that enhancing social support may reduce the negative effects of disaster distress on depression and anxiety. Therefore, comprehensive interventions incorporating disaster distress management and enhanced social support are essential in national disaster management policies and psychiatric and mental health nursing services for individuals who have experienced disasters.

Association of depression, pain, resilience, social support with post-traumatic stress in sexual abuse: A quantile regression approach.

Post-traumatic stress levels and factors influencing the sexual abuse period may differ between victims. This cross-sectional study conducted a secondary analysis of primary online survey data extracted from a previous study. We examined the extent of trauma (types, timing) and depression, pain, resilience, and social support associated with post-traumatic stress affecting the post-traumatic stress percentile. Among 3000 adults aged 19-65 years, 1223 adults experienced childhood sexual abuse, adulthood sexual abuse, or childhood and adulthood sexual abuse. We conducted descriptive statistics, multiple linear regression, and simultaneous quantile regression. Quantile regression analysis showed the 80th percentile groups in childhood sexual abuse, education, depression, and social support were significantly associated with post-traumatic stress. Depression was significantly and positively associated with post-traumatic stress. Resilience was significantly and negatively associated with post-traumatic stress in adulthood sexual abuse victims. Depression and pain were significantly and positively associated with post-traumatic stress in childhood and adulthood sexual abuse victims. Post-traumatic stress severity and influencing factors differed according to victims' age when the sexual abuse occurred, implying interventions should be tailored to each victim's post-traumatic stress level.

Polyherbal formula SC-E3 inhibits rheumatoid arthritis activity in a mouse model of type-II collagen-induced arthritis.

OBJECTIVE: SC-E3 is a polyherbal formula that contains five medicinal herbs used frequently in traditional herbal medicine. In our previous study, we demonstrated the antioxidant and anti-inflammatory effects of SC-E3. The present study examined the effects of SC-E3 in a mouse model of type-II collagen-induced arthritis (CIA). METHODS: In vivo, male DBA/1J mice were immunized by intradermal injection of bovine type-II collagen and complete or incomplete Freund's adjuvant, to induce arthritis. SC-E3 was orally administered daily for 23 days. In vitro, bone marrow-derived macrophages (BMMs) were treated with macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor-κB ligand (RANKL) in the absence or presence of SC-E3. RESULTS: Administrations of SC-E3 were found to have anti-arthritic effects in the joints of CIA mice, as evidenced by reduced paw swelling, bone erosion and deformation, inflammatory cell infiltration, and inflammation in synovial membrane. SC-E3 also reduced serum levels of tumor necrosis factor-α, interleukin-1ß, aspartate aminotransferase and alanine aminotransferase. Furthermore, tartrate-resistant acid phosphatase-positive osteoclast numbers in the joints were significantly lower in SC-E3-treated CIA mice than in CIA mice. In addition, the differentiations of BMMs to multinucleated osteoclasts induced by M-CSF and RANKL stimulation were dose-dependently reduced by SC-E3. CONCLUSION: These results suggest that SC-E3 possesses substantial anti-arthritic activity because it inhibits pro-inflammatory cytokines and osteoclastogenesis, and that SC-E3 has potential therapeutic use for the treatment of rheumatoid arthritis.

Nurse Staffing and Health Outcomes of Psychiatric Inpatients: A Secondary Analysis of National Health Insurance Claims Data.

PURPOSE: The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Korea by assessing National Health Insurance claims data. METHODS: The dataset included 70,136 patients aged 19 years who were inpatients in psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia, schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registered nurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomes included length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint, and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and system characteristics using multilevel modeling. RESULTS: Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatients per registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission. More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnotics use but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injected psycholeptics for chemical restraint. CONCLUSION: Lower nurse staffing levels are associated with negative health outcomes of psychiatric inpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatric inpatients in Korea.

Possible Application of Ecological Momentary Assessment to Older Adults' Daily Depressive Mood: Integrative Literature Review.

BACKGROUND: Ecological momentary assessment is a method of investigating individuals' real-time experiences, behaviors, and moods in their natural environment over time. Despite its general usability and clinical value for evaluating daily depressive mood, there are several methodological challenges when applying ecological momentary assessment to older adults. OBJECTIVE: The aims of this integrative literature review were to examine possible uses of the ecological momentary assessment methodology with older adults and to suggest strategies to increase the feasibility of its application in geriatric depression research and practice. METHODS: We searched 4 electronic databases (MEDLINE, CINAHL, PsycINFO, and EMBASE) and gray literature; we also hand searched the retrieved articles' references. We limited all database searches to articles published in peer-reviewed journals from 2009 to 2019. Search terms were "ecological momentary assessment," "smartphone assessment," "real time assessment," "electronic daily diary," "mHealth momentary assessment," "mobile-based app," and "experience sampling method," combined with the relevant terms of depression. We included any studies that enrolled older adults even as a subgroup and that reported depressive mood at least once a day for more than 2 days. RESULTS: Of the 38 studies that met the inclusion criteria, only 1 study enrolled adults aged 65 years or older as the entire sample; the remainder of the reviewed studies used mixed samples of both younger and older adults. Most of the analyzed studies (18/38, 47%) were quantitative, exploratory (descriptive, correlational, and predictive), and cohort in design. Ecological momentary assessment was used to describe the fluctuating pattern of participants' depressive moods primarily and to examine the correlation between mood patterns and other health outcomes as a concurrent symptom. We found 3 key methodological issues: (1) heterogeneity in study design and protocol, (2) issues with definitions of dropout and adherence, and (3) variation in how depressive symptoms were measured with ecological momentary assessment. Some studies (8/38, 21%) examined the age difference of participants with respect to dropout or poor compliance rate. Detailed participant burden was reported, such as technical problems, aging-related health problems, or discomfort while using the device. CONCLUSIONS: Ecological momentary assessment has been used for comprehensive assessment of multiple mental health indicators in relation to depressive mood. Our findings provide methodological considerations for further studies that may be implemented using ecological momentary assessment to assess daily depressive mood in older adults. Conducting more feasibility studies focusing on older adults with standardized data collection protocols and mixed-methods research is required to reflect users' experiences. Further telepsychiatric evaluation and diagnosis based on ecological momentary assessment data should involve standardized and sophisticated strategies to maximize the potential of ecological momentary assessment for older adults with depression in the community setting.

Prevalence of Traumatic Experiences in South Korean Adults.

Although a variety of traumatic experiences can impact health over the lifetime, little is known about the prevalence of such experiences in South Korea. The purpose of this study was to examine the frequencies of traumatic experiences and their differences by gender and age. South Korean adults (N = 3000) aged 19-65 years completed a self-report survey assessing childhood and adulthood trauma and sociodemographic characteristics. Overall, 79.5% of the participants reported at least one traumatic experience in adulthood. Unemployment or job loss and academic or work difficulties were commonly reported. The most distressing adulthood trauma was the unexpected death of a loved one, followed by diseases in loved ones. Childhood trauma was higher in males than in females. In males, childhood trauma was higher at a younger age, but in females, it was higher at an older age. Adulthood trauma was higher in females than in males and at older ages for both males and females. The current findings demonstrate the differences in traumatic experiences by gender and age in the South Korean general population. These results could help improve assessment of and targeted intervention for psychological trauma through trauma-informed strategies in public health practice.

Functional Health in Korean Middle-Aged Women with Poor Sleep Quality.

PURPOSE: To develop and test a structural model of functional health in middle-aged women based on the theory of unpleasant symptoms. METHODS: The direct and indirect effects of menopause status, childhood trauma, post-traumatic stress, social support, and sleep quality on functional health of 264 Korean women were examined. FINDINGS: Menopause status and poor sleep quality had a negative direct effect and social support had a positive direct effect on functional health. Menopause status had a negative indirect effect on functional health through poor sleep quality. CONCLUSIONS: Biopsychosocial nursing intervention programs need to be developed to improve functional health in middle-aged women. IMPLICATIONS FOR NURSING PRACTICE: It is important to mediate quality of sleep to improve functional health in middle-aged women. 목적 불쾌증상 이론을 바탕으로 중년 여성의 건강기능을 평가하기 위함이다. 방법 264명의 한국 여성을 대상으로 건강기능에 영향을 미치는 폐경, 아동기 외상, 외상 후 스트레스, 사회적 지지의 직ㆍ간접적 영향을 확인하였다. 결과 폐경과 낮은 수면의 질은 건강기능에 부적 영향을 미쳤으며, 사회적 지지는 건강기능에 정적 영향을 미쳤다. 폐경은 건강기능에 간접적 영향을 미쳤다. 결론 중년여성의 건강기능을 증진하기 위해 신체ㆍ심리ㆍ사회적 요인을 고려한 통합적 중재가 필요하다. 간호실무 적용점: 중년여성의 건강기능을 유지하기 위해 수면의 질을 중재하는 것이 중요하다.