Role performance and factors affecting quality of life in bladder cancer survivors with ileal orthotopic neobladder.

Objective: Bladder cancer survivors with neobladder experience changes in role performance and quality of life (QoL) due to various symptoms and problems, but related studies are limited. Therefore, this study attempted to explore the QoL and factors influencing it in bladder cancer survivors with neobladder. Methods: A cross-sectional descriptive design was used. Data were collected from 100 bladder cancer survivors with a neobladder using the European Organisation for Research and Treatment of Cancer QLQ-C30 and Muscle-Invasive Bladder Cancer Module, the Patient Activation Measure 13, the Enforced Social Dependency Scale, and the Multidimensional Scale of Perceived Social Support. Factors affecting the QoL were identified using multiple regression analysis. Results: QoL significantly differed by daily pad usage, need for clean intermittent catheterization, and role performance. QoL was correlated with urinary symptoms and problems, future perspective, abdominal bloating and flatulence, body image, role performance, and social support. Role performance, body image, and the need for clean intermittent catheterization were identified as the factors affecting QoL. Conclusions: The study highlights the importance of bladder cancer survivors continuing their roles at home, at work, and in society after neobladder reconstruction. Specifically, continuing recreational and social activity positively affects QoL, even if the activity range is modified. To help with their role performance, institutional support and changes in social perception are needed. Additionally, education and interventions, including body image enhancement, symptom management, and self-care, should be developed and applied to improve their QoL.

Social group membership, burnout, and subjective well-being in new nurses in the life transition period: A cross-sectional study.

AIM: To assess differences in social group memberships and burnout levels by work tenure among new nurses and identify factors associated with their subjective well-being. DESIGN: A cross-sectional study. METHODS: Participants were 356 registered nurses who had fewer than 3 years of work tenure. Data were collected from February-March 2021. Participants' social identity, burnout, and subjective well-being were assessed using validated questionnaires. STROBE checklist was applied. RESULTS: Multiple group membership was positively associated with life satisfaction and positive affect and negatively with burnout. Burnout influenced new nurses' negative effect in their life transition period. To improve new nurses' subjective well-being, it is essential to focus on their social group membership, encourage participation in group activities, and improve access to sociopsychological resources that can help them take their first steps as professional staff and develop as healthy members of society, which will foster sustainable healthcare systems.

Perceived New Normal and Inner Strength on Quality of Life in Breast Cancer Patients Receiving Adjuvant Endocrine Therapy.

OBJECTIVE: This study aimed to investigate the differences in symptom experience, inner strength, adherence, and quality of life (QOL) according to the perception of the new normal, and identify the factors related to the QOL of breast cancer patients undergoing adjuvant hormonal therapy based on the theory of inner strength in women. METHODS: This cross-sectional study recruited patients with breast cancer receiving adjuvant hormonal therapy in the National Cancer Center. Demographic and clinical characteristics were recorded, and patients were assessed using the M. D. Anderson Symptom Inventory, Connor-Davidson Resilience Scale 2, Morisky Medication Adherence Scale 8, and Functional Assessment of Cancer Therapy-General Scale. RESULTS: After the breast cancer diagnosis, the perception of the new normal showed a significant dependence on pill count and emotional and functional well-being. The hierarchical regression analysis indicated that the new normal, symptom interference, and inner strength after adjusting for age, time since diagnosis, and receiving chemotherapy were significant predictors of QOL in breast cancer patients receiving adjuvant endocrine therapy. The model accounted for 47.8% of the variance in QOL. CONCLUSIONS: The theory of inner strength might be a potential pathway in health care to improve patients' QOL during long-term medication. The results of this study have both theoretical and applied implications. The findings can be utilized as evidence for developing an effective intervention that improves the QOL and adherence to adjuvant hormonal therapy of breast cancer patients.

The mediating effect of resilience on happiness of advanced lung cancer patients.

PURPOSE: To identify the perceived level of lung cancer stigma, resilience, and happiness among advanced lung cancer patients during treatment, and to analyze the mediating effect of resilience in the relationship between stigma and happiness. METHODS: A cross-sectional study design was used. A total of 184 patients diagnosed with advanced lung cancer were recruited from the National Cancer Center in Korea. Lung cancer stigma, resilience, and happiness were measured using questionnaires. RESULTS: Findings indicate that whereas lung cancer stigma had a negative correlation with resilience and happiness, resilience had a positive correlation with happiness. There was a significant indirect effect of stigma on happiness through resilience, indicating a mediating effect of resilience. CONCLUSIONS: The results make significant contributions, like the importance of encouraging patients with non-judgmental approach, to clinical practices related to happiness of individuals with advanced cancer. It suggests that the stigma of advanced lung cancer patient can be overcome with enough resilience, and patients may experience happiness during treatment.

Unit work environment, psychological empowerment and support for patient activation among nurses.

AIMS: To investigate the relationship between the unit work environment and psychological empowerment of nurses and their perceptions of patient activation. BACKGROUND: Nurses' support for active patient roles in the care process is critical for better patient outcomes. The factors influencing nurses' support for patient activation should be thoroughly investigated. METHODS: This study was a cross-sectional secondary data analysis using the survey data of 1,042 nurses in 98 units at six hospitals in Korea. RESULTS: Nurses with perceptions that their work was valuable and autonomy in their work were more likely to work in units where managers had greater managerial and leadership skills and staffing and resources were sufficient. Those with confidence in their work were more likely to work in units with adequate staffing and resources. Nurses who worked with adequate staffing and resources and considered their work meaningful were more likely to perceive patient activation as more important. CONCLUSION: Favourable work environments at unit level and psychological empowerment at nurse level can strengthen nurses' support for patient activation. IMPLICATIONS FOR NURSING MANAGEMENT: To strengthen nurses' support for active patient roles, organisations should ensure optimal staffing and resources to each unit and help nurses find value in their work.

Work Schedule Characteristics, Missed Nursing Care, and Organizational Commitment Among Hospital Nurses in Korea.

PURPOSE: This study describes Korean nurses' work schedule characteristics and identifies their components to investigate associations of work schedule components with missed nursing care and organizational commitment. DESIGN: This cross-sectional secondary analysis used survey data of 1,057 nurses in 111 units at six hospitals in South Korea. Data were collected between April 2017 and March 2018. METHODS: A self-administered survey, including seven work schedule characteristic items, the Korean version of the MISSCARE Survey, and the Korean version of the Organizational Commitment Questionnaire, was employed. To construct independent components of work schedule characteristics, a principal component analysis was performed. The associations of work schedule components with missed nursing care and organizational commitment were analyzed using multiple linear regression models with generalized estimating equation methods. FINDINGS: The average number of daily work hours was 9.7. Nearly half of the study population worked while sick once or more per month. The two components of nurses' work schedule characteristics were "long work hours" and "lack of rest," and these components showed variations between units. Unhealthy work schedule components were linked to frequently missed nursing care and decreased organizational commitment. CONCLUSIONS: This study showed that proper work hours and adequate rest are important to reduce missed nursing care tasks and enhance organizational commitment, both of which are critical for better patient care and organizational outcomes. CLINICAL RELEVANCE: Healthcare organizations should provide adequate nursing staff and assign reasonable workloads. Furthermore, hospitals should periodically monitor the work schedule characteristics of nurses and actively intervene in cases of scheduling issues to resolve them.

Knowing in Nurses' Belief and Attitude about Patient Activation: A Validation of the Korean Clinician Support for Patient Activation Measure Using Rasch Analysis.

BACKGROUND: Patient engagement is considered a critical factor in improving healthcare delivery. This study aimed to test the Korean version of the Clinician Support for Patient Activation Measure (CS-PAM) using Rasch analysis, and to explore nurses' beliefs about patient self-management. METHODS: A cross-sectional, exploratory study design was employed. The staff nurses who were recruited from six hospitals were requested to complete the Korean CS-PAM. Their responses were subsequently subjected to Rasch analysis to validate the Korean CS-PAM. The CS-PAM was paraphrased into Korean using the standardized forward-backward translation method. RESULTS: The internal consistency of the scale had good Cronbach's alpha value. For all items, the infit and outfit statistics fell well within the acceptable range of 0.5-1.5. This measure formed a unidimensional Guttman-like scale that explained 54.7% of the variance. CONCLUSIONS: The Korean version of the CS-PAM showed good psychometric properties and appeared to be consistent with the meaning of the original CS-PAM. However, the items have a somewhat different ranking order when compared to the English and Dutch versions. The instrument might be useful for identifying the supportive beliefs and attitudes of nurses or healthcare providers in order to improve patient activation in healthcare.

A Narrative Inquiry into the Adjustment Experiences of Male Bladder Cancer Survivors with a Neobladder.

This study aimed to explore three male bladder cancer survivors' adjustment experiences after neobladder reconstruction. A narrative inquiry method was adopted to closely investigate the individual experiences of bladder cancer survivors and the meaning of their experiences. Three themes emerged regarding physical and mental changes resulting from neobladder reconstruction: difficulty urinating or holding urine, sexual dysfunction and sexlessness, and stress resulting from urinary incontinence. Life changes following surgery varied across each participant and included 'unwanted retirement', 'quitting drinking and leaving work', and 'beginning of a restrained life'. The theme of adjustment experience emerged, comprising 'active exploration of resolutions', 'accepting change and partial return to daily life', and 'living in line with the health condition and family wishes'. Bladder cancer survivors with a neobladder, in this study, continue to adjust to changes in the voiding mechanism, various symptoms including incontinence, and life changes even after surgical cancer resection. The findings suggest that not only therapeutic interventions, but additional interventions are also needed to assist bladder cancer survivors with adjustment, rehabilitation, and return to society. These findings are also expected to be used both to educate bladder cancer survivors with a neobladder and to develop policies to help them.

Feasibility of the Schizophrenia Hope Scale-9: A Psychometric Study.

Hope is essential in rehabilitating persons with schizophrenia, though scales to measure hope are not appropriate for this population. The purpose of this cross-sectional study was to identify the psychometric properties of the Schizophrenia Hope Scale-9 (SHS-9) using data from 83 people with schizophrenia in four mental health centers and 762 healthy persons from two universities in South Korea. The total SHS-9 score is calculated by adding all items' scores and ranges from 0 to 18. The mean (standard deviation) SHS-9 score of the participants with schizophrenia and healthy participants was 11.53 (SD = 4.78) and 14.78 (SD = 3.19), respectively. Lower scores indicate a lower level of hope. The Cronbach's alpha coefficient was 0.92 with a four-week test-retest reliability of 0.89. Criterion-related construct validity was established by examining the correlation between the SHS-9 and the State-Trait Hope Inventory scores. Divergent validity was identified through a negative relationship of SHS-9 with the Beck Hopelessness Scale. In persons with schizophrenia and healthy college students, Bartlett's test of sphericity yielded χ2 = 465.03 (p < 0.001) and χ2 = 2679.24 (p < 0.001) respectively. The values of the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy were 0.89 and 0.90, respectively. The construct validity of the SHS-9 was confirmed through principal component analysis with extraction methods, which resulted in a one-factor solution, accounting for 61.83% of the total item variance. This study provides evidence for the validity and reliability of the SHS-9; therefore, it could be used to study the relationships between hope and other variables (e.g., depression and recovery) in persons with schizophrenia and measure the effect of psychosocial interventions on their hope.

Breast and cervical cancer screening for risk assessment in Cambodian women.

The estimated mortality rates for breast and cervical cancer in Cambodia are high, perhaps because the Cambodian population lacks information about their detection and prevention. This cross-sectional study assessed the distribution of cervical cancers among and the behavioural and clinical characteristics of Cambodian women. It comprised 1039 Cambodian women who were interviewed between August 2013 and January 2016; the interviews were conducted in person using structured questionnaires. Among the participants, 801 (77.2%) and 709 (68.3%) had heard of cervical cancer and cervical cancer detection tests, respectively. However, 830 (80.2%) had never undergone a Pap smear, and 633 (60.9%) had never heard of breast self-examination. Despite the high mortality rates for breast and cervical cancer in Cambodia, only a small percentage of the participants had risk factors (e.g. smoking, alcohol consumption) for female cancers. A nationwide survey of the knowledge, attitudes and practices related to female cancers is recommended.Impact StatementWhat is already known on this subject? The estimated incidence and mortality rates of breast and cervical cancers in Cambodia are high. How much Cambodian women know about these cancers and whether they are receptive to cancer screening are questions requiring further study.What do the results of this study add? To our knowledge, this is the first study to describe the female cancer-related behavioural and clinical characteristics of Cambodian women. We show that rural Cambodian women are mostly unaware of breast and cervical cancer screening and that only a small percentage had risk factors for these cancers, despite the high incidence of these cancers in Cambodia.What are the implications of these findings for clinical practice and/or further research? Our findings potentially aid the design of programmes that increase awareness of breast and cervical cancers in Cambodia. Such programmes would be expected to reduce the incidence and mortality rates of these cancers in this country. Nationwide screening programmes for female cancers should be implemented in Cambodia.

Illness Perceptions, Self-Care Management, and Clinical Outcomes According to Age-Group in Korean Hemodialysis Patients.

Illness perception, formed in social-cultural contexts, is the driving force for health behavior. Age difference can affect health outcomes due to its association with socioeconomic status. The purpose of this study is to determine the relationship between illness perception, self-care management, and clinical outcomes according to the age group in hemodialysis patients. A cross-sectional study was conducted. Using the Brief Illness Perception Questionnaire (BIPQ) and Patient Activation Measure (PAM) 13, clinical outcomes, such as serum phosphorus, potassium, hemoglobin, and albumin were investigated in maintenance hemodialysis patients. Illness perception, self-care management, and clinical outcomes in 189 hemodialysis patients were different according to age group. Younger hemodialysis patients had the lowest illness perception and the highest serum phosphorus. Illness perception was associated with self-care management and clinical outcomes. After the adjusted age, the association between illness perception and self-care management and the association between illness perception and phosphorus were reduced, while the association between illness perception and potassium increased. Uncontrolled phosphorus in younger hemodialysis patients can increase the risk of cardiovascular complications and mortality. To improve self-care management and clinical outcomes in hemodialysis patients, reconstruction, or expansion of illness perception needs to be differentiated according to age group.

Does Holding Back Cancer-Related Concern Affect Couples' Marital Relationship and Quality of Life of Patients with Lung Cancer? An Actor-Partner Interdependence Mediation Modeling Approach.

PURPOSE: This study was designed to examine both actor and partner effects of perceived marital relationship on quality of life, as well as the mediating effect of holding back cancer-related concerns. METHODS: This was a cross-sectional study in an outpatient setting. Participants were 150 couples consisting of patients with lung cancer and their spouses. Perceived marital relationship, holding back cancer-related concerns, and quality of life were measured with self-report scales. Actor and partner effects on quality of life were analyzed using the actor-partner interdependence mediation model by using structural equation modeling. RESULTS: A couple's quality of life had a significant direct actor effect on the perceived marital relationship. However, the partner effect and the indirect effect of holding back cancer-related concerns on quality of life was not significant. CONCLUSION: When patients with lung cancer and their spouses perceived their marital relationship positively, they assessed their quality of life positively. They were also found to be less hesitant when talking about cancer-related concerns. However, holding back on talking concerns did not have a significant impact on the quality of life (of either oneself or the spouse). Therefore, nurses should first check how they perceive their marital relationship before encouraging communication between patients with lung cancer and their spouses. Nurses can assess these risk factors and intervene if needed, along their cancer trajectory.

Authentic leadership, job satisfaction and organizational commitment: The moderating effect of nurse tenure.

AIMS: To examine the associations between unit managers' authentic leadership with job satisfaction and organizational commitment and to investigate whether nurse tenure has a moderating effect on these associations. BACKGROUND: Authentic leaders create trusting relationships with their staff and help nurses become more satisfied with their jobs and committed to their organizations. Because nurses have different perceptions of their working environments based on their tenure, the effectiveness of managerial leadership differ accordingly. METHODS: This study is a cross-sectional secondary analysis using survey data from 1,118 staff nurses. To determine the significant tenure range for the associations between authentic leadership, job satisfaction and organizational commitment, the Johnson-Neyman method was used. RESULTS: Authentic managerial leadership perceived by staff nurses had positive associations with job satisfaction and organizational commitment. The strengths of these associations were attenuated with nurse tenure and were no longer significant for nurses with more than 20 years of tenure. CONCLUSIONS: Although authentic leadership in managers was effective, the strengths of its effectiveness varied based on nurse tenure. IMPLICATIONS FOR NURSING MANAGEMENT: According to nurse tenure, differentiated approaches are needed to increase the job satisfaction and organizational commitment of staff nurses.

Depression and health-related quality of life among Cambodian patients with cancer.

BACKGROUND: Symptom assessment and quality of life (QoL) are considered two of the most important factors in the overall care of cancer patients. Although cancer is one of the leading causes of death after communicable disease in Cambodia, the QoL of Cambodian cancer patients has not been examined previously. This study aimed to describe the QoL of cancer patients in Cambodia. METHODS: A cross-sectional study was conducted with cancer patients who visited Khmer-Soviet Friendship Hospital in Phnom Penh. Two hundred patients participated in this study. The inventory comprised two previously validated scales: the Center for Epidemiological Studies Depression Scale-10 (CESD-10) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30. Descriptive analyses, independent samples t-tests, and Pearson's correlation analysis were performed to examine the differences and relationship between study variables. RESULTS: The mean global health score was 51.62, and 58.5% of the participants had depressive symptom. The global health score was statistically significantly lower in depressive patients. The QoL was negatively correlated with depression, but positively and significant correlated with physical function, role function, emotional function, cognitive function, and social function. CONCLUSION: This study is the first to describe the QoL of Cambodian cancer patients. Our findings suggest that more attention should be paid to psychological concerns and symptom management in Cambodian cancer patients. Appropriate management could be effective in improving the QoL of cancer patients.

Parental Occupational Status and Suicidal Ideation in Adolescent: Cross-Sectional Secondary Data Analysis.

PURPOSE: This study aimed to identify the effect of parental occupational status on adolescents' suicidal ideation from a representative sample of the Korean population. DESIGN AND METHODS: A cross-sectional analysis was performed. Participants were 3201 adolescents aged 12-18 years from the Korean National Health and Nutrition Examination Survey. RESULTS: Adolescents experiencing suicidal ideation were found to be more likely to be female, have a history of smoking or alcohol use, a shorter sleep duration, greater perception of stress, and greater experience of depression when compared to those who did not report suicidal ideation. There was a statistically significant difference in perception of stress, experience of depression, and experience of suicidal ideation according to parental occupational status. Adolescents' suicidal ideation was associated with parents' employment status, work status, work schedule patterns, and working hours per week. CONCLUSIONS: Parental occupational status was associated with adolescents' suicidal ideation, but fathers' and mothers' occupational status affected children's suicidal ideation in different ways. Adolescents' suicidal ideation seems to have been affected by economic difficulty and stress, resulting from the father's occupational status, amount of time spent interacting with the mother, and the mother's employment status. Policies are needed to improve the quality of employment to reduce the financial difficulties and stresses of the father. A strategy for work-family compatibility is needed so that the mother can have enough time with her children while she has a job. PRACTICE IMPLICATIONS: It is necessary to consider parents' occupational status when assessing adolescents' suicidal ideation and providing interventions.

Assessment of the awareness and knowledge of cancer survivors regarding the components of metabolic syndrome.

This study aimed to assess the prevalence of metabolic syndrome and the level of knowledge and awareness of its related conditions in a sample of cancer survivor patients. In this cross-sectional survey, a self-reported questionnaire was administered to outpatients aged >20 years with a diagnosis of cancer. This self-reported questionnaire on patient demographic characteristics, disease characteristics, and knowledge and awareness of metabolic syndrome was used as an instrument to assess patient's knowledge of metabolic syndrome. A total of 88 participants were included; of these 34.1% had metabolic syndrome, although only 6.8% of participants were diagnosed with metabolic syndrome. Over half of the participants had heard about metabolic syndrome; however, 70% of the participants did not know about the blood tests for the diagnosis of metabolic syndrome although they were aware of the physical measurements, such as weight, blood pressure, and waist circumference. The highest proportion of correct answers for questions about metabolic syndrome was related to stroke, while the lowest was about cholesterol levels. The proportions of correct answers for selected parameters were as follows: diabetes, 39.1%; adiposity, 47.2%; hypertension, 46.8%; cholesterol levels, 36.7%; arteriosclerosis, 45.5%; myocardial infarction, 37.8%; and stroke, 62.8%. The results suggest that the level of knowledge of metabolic syndrome among the cancer survivors in our sample was poor, although more than one-third of them had metabolic syndrome. Thus, it is essential to educate cancer survivors about metabolic syndrome and its related conditions to improve their overall health and quality of life.

Association between Awareness of Nutrition Labels and Menstrual Cycle Irregularity in Korean Women: The Fifth Korea National Health and Nutrition Examination Survey (2010~2012).

PURPOSE: The aim of this study was to identify the relationship between awareness of nutrition labeling and menstrual cycle irregularity in women from a nationally representative sample of the Korean population. METHODS: A cross-sectional analysis was performed using hierarchical multivariable logistic regression analysis models. A total of 4,324 women aged 19~54 years from the 2010~2012 Korean National Health and Nutrition Examination Survey participated in the study. The participants were classified into three groups based on self-report responses to a questionnaire about their awareness of nutrition labels: Reading, Not-Reading, and Not-Knowing Groups. RESULTS: The Reading, Not-Reading, and Not-Knowing Groups comprised 46.4%, 44.9%, and 8.7% of the participants, respectively, and 53.6% of the participants had never used nutrition labels. In the Not-Knowing Group, irregular menstrual cycles for more than 3 months were significantly more common than women with irregular menstrual cycles for up to 3 months and women with regular menstrual cycles. Women in the Not-Knowing Group were more likely to exhibit menstrual cycle irregularity (adjusted odds ratio: 1.63, 95% confidence interval: 1.10~2.41) compared to women in the Reading Group after adjusting for age, body mass index, smoking status, alcohol intake, exercise regularity, stress, depression, suicidal ideation, metabolic syndrome, age at menarche, parity, and use of oral contraceptives. CONCLUSION: No awareness of nutrition labeling appears to be associated with a higher prevalence of menstrual cycle irregularity in a nationally representative group of Korean women.

Risk of secondary lymphedema in breast cancer survivors is related to serum phospholipid fatty acid desaturation.

PURPOSE: Secondary lymphedema is a common irreversible side effect of breast cancer surgery. We investigated if risk of secondary lymphedema in breast cancer survivors was related to changes in serum phospholipid fatty acid composition. METHODS: Study subjects were voluntarily recruited into the following three groups: breast cancer survivors who had sentinel lymph node biopsy without lymphedema (SLNB), those who had auxillary lymph node dissection without lymphedema (ALND), and those who had ALND with lymphedema (ALND + LE). Body mass index (BMI), serum lipid profiles, bioimpedance data with single-frequency bioimpedance analysis (SFBIA), and serum phospholipid compositions were analyzed and compared among the groups. RESULTS: BMI, serum total cholesterol (total-C), and low-density lipoprotein cholesterol (LDL-C) and SFBIA ratios increased only in the ALND + LE. High polyunsaturated fatty acids (PUFAs) and high C20:4 to C18:2 n-6 PUFAs (arachidonic acid [AA]/linoleic acid [LA]) was detected in the ALND and ALND + LE groups compared to SLNB. The ALND + LE group showed increased activity indices for delta 6 desaturase (D6D) and D5D and increased ratio of AA to eicosapentaenoic acid (AA/EPA) compared to the ALND and SLNB groups. Correlation and regression analysis indicated that D6D, D5D, and AA/EPA were associated with SFBIA ratios. CONCLUSION: We demonstrated that breast cancer survivors with lymphedema had elevated total PUFAs, fatty acid desaturase activity indices, and AA/EPA in serum phospholipids. Our findings suggested that desaturation extent of fatty acid composition might be related to the risk of secondary lymphedema in breast cancer survivors.

Serum fibronectin 1 and ApoE levels increase with risk of lymphedema in Korean breast cancer survivors.

PURPOSE: Lymphedema is an irreversible disorder often seen as a postoperative side effect in breast cancer survivors. We aimed to identify serum factors that are associated with lymphedema risk in breast cancer survivors. METHODS: This study recruited 60 volunteer breast cancer survivors. Participants were classified into either a CTRL group who underwent sentinel lymph node biopsy (SLNB), a RISK group who underwent axillary lymph node dissection (ALND) with removal of fewer than five lymph nodes, or an LE group who underwent ALND with removal of more than five lymph nodes. Bioimpedance was measured to determine the ratio of extracellular water (ECW) to total cellular water (TCW) and single-frequency bioimpedance analysis (SFBIA) ratios. Serum lipid profiles were compared among the groups using label-free quantitative proteomics with the nano-liquid chromatography (LC)-tandem mass spectrometer (MS/MS) and emPAI method. RESULTS: The CTRL, RISK, and LE groups had similar body weights and body mass indexes (BMIs) (<25 kg/m(2)). The LE group showed a higher grade of lymphedema severity compared to the RISK and CTRL groups. Lymphedema indices such as the ECW/TCW ratio and SFBIA ratio at 1 and 5 kHz were greatly increased in the LE group. Serum total cholesterol (total-C) level was higher in the LE group without affecting atherogenic index. Serum proteomics revealed that fibronectin 1 (FN1), apolipoprotein E (ApoE), antithrombin (ANT3), and complement C4 had different abundance values among the groups. ELISA confirmed that FN1 and ApoE were significantly elevated in both the RISK and LE groups compared to the CTRL group. CONCLUSIONS: Changes in serum FN1 and ApoE levels were detected prior to changes in serum total-C level and lymphedema indices such as SFBIA ratio. Therefore, elevation in serum FN1 and ApoE concentrations could likely be used to monitor the risk of lymphedema in breast cancer survivors.

[Structural Equation Modeling of Quality of Work Life in Clinical Nurses based on the Culture-Work-Health Model].

PURPOSE: The purpose of this study was to construct and test a structural equation model of quality of work life for clinical nurses based on Peterson and Wilson's Culture-Work-Health model (CWHM). METHODS: A structured questionnaire was completed by 523 clinical nurses to analyze the relationships between concepts of CWHM-organizational culture, social support, employee health, organizational health, and quality of work life. Among these conceptual variables of CWHM, employee health was measured by perceived health status, and organizational health was measured by presenteeism. SPSS21.0 and AMOS 21.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factors affecting quality of work life among clinical nurses. RESULTS: The goodness-of-fit statistics of the final modified hypothetical model are as follows: χ²=586.03, χ²/df=4.19, GFI=.89, AGFI=.85, CFI=.91, TLI=.90, NFI=.89, and RMSEA=.08. The results revealed that organizational culture, social support, organizational health, and employee health accounted for 69% of clinical nurses' quality of work life. CONCLUSION: The major findings of this study indicate that it is essential to create a positive organizational culture and provide adequate organizational support to maintain a balance between the health of clinical nurses and the organization. Further repeated and expanded studies are needed to explore the multidimensional aspects of clinical nurses' quality of work life in Korea, including various factors, such as work environment, work stress, and burnout.