[The Experience of Gynecologic Cancer in Young Women: A Qualitative Study].

PURPOSE: This study aimed to understand the experiences of women under 40 years of age with gynecologic cancer. METHODS: Semi-structured individual in-depth interviews were conducted with 14 Korean female patients aged 21~39 years with gynecologic cancer. The data were analyzed using Corbin and Strauss' grounded theory approach, including open coding, context analysis, and integrating categories. RESULTS: Grounded theory analysis revealed nine categories and a core category of 'the journey to find my life after losing the life as a typical woman.' The categories that emerged as the conditions are 'Unwelcomed guest, cancer,' 'Completely devastated life as an ordinary woman,' 'Uncertain future,' 'Losing my physical characteristics as a woman,' and 'Life tied with treatments.' The actions/interactions were'Decrease of interpersonal relationships,' 'A lonely battle to overcome alone,' and 'The power to overcome hardships.' The consequence was 'Live my own life.' CONCLUSION: This study contributes to the development of a substantive theory of the experience of gynecologic cancer in young women, which has been on the rise in recent years. The study's results are expected to be used as a basis for providing nursing care to help young women with gynecologic cancer adapt to their disease.

Factors Affecting Human Papillomavirus Vaccination in Men: Systematic Review.

BACKGROUND: Despite the high risks associated with human papillomavirus (HPV), the HPV vaccination rate of men is far lower than women. Most previous review studies have focused on female vaccination and related affecting factors. However, previous studies have reported that the factors affecting HPV vaccination differ by gender. OBJECTIVE: The aim of this review was to identify the factors affecting HPV vaccine initiation in men through a systematic review approach. METHODS: A literature review was conducted across 3 central electronic databases for relevant articles. A total of 30 articles published between 2013 and 2019 met the inclusion criteria and were reviewed in this study. RESULTS: In total, 50 factors affecting HPV vaccination in men were identified, including 13 sociodemographic factors and social structure factors, 12 belief-related variables, 4 family factors, 4 community factors, 14 variables related to needs, and 3 environmental factors. CONCLUSIONS: To increase HPV vaccination rates in men, strategies targeting young males and their families should consider frequent visits to or contact with health care providers so that health care professionals can provide recommendations for HPV vaccination.

Factors influencing health-related quality of life in adolescent girls: a path analysis using a multi-mediation model.

BACKGROUND: Recent studies have reported gender differences in adolescents' health-related quality of life (HRQOL), with females scoring significantly lower than males. Researchers have identified the female puberty process as one of the causes of the differences in HRQOL between male and female adolescents. This study examines mechanisms of how social support, dietary habits, sleep quality, and depression contribute to predicting HRQOL in relation to menstrual health among adolescent girls. METHODS: A cross-sectional study was conducted with 295 students recruited from middle and high schools in Korea using a self-report questionnaire. A multi-mediation model was constructed based on previous literature and tested using path analysis with AMOS, version 21.0. RESULTS: The study results showed that menstrual health, social support, sleep quality, dietary habits, and depression had significant effects on HRQOL. Both sleep quality and depression had significant direct effects on menstrual health. Dietary habits, social support, sleep quality, and depression had significant indirect effects on HRQOL, mediated through menstrual health. According to serial mediation analysis, the path from social support to HRQOL via dietary habits → sleep quality → depression → menstrual health → HRQOL was significant. However, mediation models including the path of dietary habits → depression were not supported. The study variables explained 57% of the total variance for HRQOL. CONCLUSIONS: The findings suggest menstrual health is an important factor that mediates the effects of eating, sleeping, psychological health, and social support on HRQOL. Early complaints about sleep disorders and depressive symptoms with poor dietary habits could be an ominous sign for adolescent girls at high risk of menstrual problems and lower HRQOL. Empirical evidence from this study suggests the need to develop and test interventions addressing multiple modifiable behavioral and psychosocial factors to improve HRQOL in adolescent girls. Interventions or supportive systems that aim to improve eating habits and sleep quality thereby achieving a healthier lifestyle need to be developed and incorporated into school health services.

Menstrual Cycle Patterns and the Prevalence of Premenstrual Syndrome and Polycystic Ovary Syndrome in Korean Young Adult Women.

Menstruation is one of the important indicators of reproductive health. Therefore, in order to improve the reproductive health of women in puberty and early adulthood, it is necessary to investigate menstrual health and symptoms. This cross-sectional descriptive correlational study was conducted to identify young women's menstrual cycle patterns, prevalence of Premenstrual Syndrome (PMS), Polycystic Ovary Syndrome (PCOS) and the relationships of health-related factors according to menstrual regularity and PCOS. 462 women participated in the first phase of the study and completed the menstrual health and health-related behaviors questionnaire. In the second phase, 88 women with irregular menstruation in phase one had blood tests taken and body composition measured. As a result, Menarche was slightly later in irregular menstruation group. Women with regular menstruation had a mean number of 11.7 menstrual cycles over the past year, 93.0% of them reported a normal menstruation cycle frequency (21-35 days), 95.2% reported a normal duration (2-7 days) and 55.9% of participants had heavy menstrual bleeding. In the irregular menstrual group, there were higher percentages of underweight and obese women as well as more women experiences weight and diet changes. The estimated prevalence rates of PMS and PCOS were 25.5%, 5.2% respectively. This study provides updated basic data about menstrual health among Korean young women but more extensive and sophisticated studies are needed in the future.

Development and Effects of College-Based Lifestyle Modification Program for Menstrual Health of Young Adult Women with Irregular Menses: A Randomized Controlled Trial.

Purpose: This study was conducted to develop the 'College-based Lifestyle Modification Program' (College-based LMP) for young adult women with irregular menstruation and examine its effects after intervention. Methods: The College-based LMP consisted of small group education, individual physical exercise counseling/training, individual diet counseling, and feedback and support. Participants were comprised of 38 females who reported less than 10 irregular menstruations in a year and were randomly assigned to the experimental and control groups. The primary outcome variables consisted of menstrual cycle index (MCI), sex hormone binding globulin (SHBG), and androgenic profile (testosterone-T, free androgen index-FAI), while the outcome variables included premenstrual symptoms (PMS), menstrual volume, body composition parameters, glycemic parameters (fasting blood sugar-FBS, insulin, HOMA-IR), sleep duration, perceived stress, and nutrient intake.. Results: There were no significant differences in primary outcome variables (MCI, SHBG, T, and FAI). In the variables, there were no significant differences except for the partial domain of PMS (symptoms of depression and anxiety) and sleep duration. Conclusions: The study was significant in that it demonstrated the importance of lifestyle, which could provide ordinary young adult women with healthy menstruation. The College-based LMP needs to be elaborated with further studies.

Development and psychometric validation of the Menstrual Health Instrument (MHI) for adolescents in Korea.

The aims of the researchers were to develop and test initial psychometric properties of the Menstrual Health Instrument, a measure of menstrual health in adolescents that comprehensively evaluates menstrual health. Data were collected with a convenience sample of 230 Korean adolescent girls. As a result of exploratory factor analysis with the 29-item instrument, five factors were extracted: affective symptoms, somatic symptoms and school life, daily habits for menstrual health, menstrual cycle characteristics, and attitudes and perceptions on menstruation. The reliability and validity estimates indicate the Menstrual Health Instrument could be used for screening in school or community settings.

Application and Effect of Mobiletype-Bone Health Intervention in Korean Young Adult Women with Low Bone Mass: A Randomized Control Trial.

PURPOSE: This randomized control trial was designed to examine the effect on the self-managing ability for promoting bone health of mobile type-bone health intervention (mobile type-BHI). METHODS: The mobile type-BHI consisted of a mobile application called "Strong bone, Fit body" (SbFb) and group education. A total of 82 college women with low bone mass (Z score < -1) participated. They were assigned randomly to three groups, experimental group I, (n = 28), experimental group II (n = 32), and control group (n = 22). This study ran from June 2014 to January 2015. The outcome variables were bone mineral density, minerals related to bone metabolism (calcium, phosphorus, vitamin D), biochemical markers related to bone remodeling (osteocalcin, C-terminal telopeptide, sclerostin), food intake diary by 24 hours recall, and psychosocial variables related to bone health (knowledge, health belief and self-efficacy). Data were analyzed using SAS program and a computer aided nutritional analysis program. RESULTS: Both the experimental group I, who used mobile type-BHI, and experimental group II, who only received group education, showed outcomes regarding knowledge of the benefits of exercise and calcium as compared with the control group. The two experimental groups also demonstrated results in the serum levels of calcium, vitamin D, and sclerostin compared to those of the control group. CONCLUSION: Although both experimental groups exhibited positive outcomes in regards to the promotion of bone health, this study did not show an additional effect of the mobile application on self-management ability for the promotion of bone health. Nonetheless, the SbFb application is very meaningful as it is the first application developed with the aim of improving women's bone health.

Health-Related Quality of Life During the Menopausal Transition: Testing a Theoretical Model.

The purpose of this study was to test the hypothetical model of health-related quality of life (HRQOL) during the menopausal transition. The model was developed to test specific components of the Wilson and Cleary's model for HRQOL. A cross-sectional, correlational study was carried out using self-report questionnaires on a convenience sample of 162 Korean women in the menopausal transition. The model was tested by a path analysis using Analysis of Moment Structure (AMOS) program. The path analysis showed that 5 affecting variables explained 69% of the variance in HRQOL during the menopausal transition. Based on the results, the Wilson and Cleary's model may be useful in explaining HRQOL during the menopausal transition. Symptoms, functional status, and health perceptions mediated the effect of individual and environmental characteristics on HRQOL. However, the results suggest that some paths need to be added or modified in the model. To date, most research using Wilson and Cleary's model has been conducted in the United States, Africa, and Europe (e.g., Austria, Norway, and Spain). This study shows the applicability of the model in Asian people.

The usefulness of a mobile device-based system for patient-reported outcomes in a spine outpatient clinic.

BACKGROUND CONTEXT: Patient-reported outcomes (PROs) are typically collected using a paper form, but this format is cumbersome to incorporate into outpatient clinic visits as well as in research. Therefore, we developed a mobile device-based system (mobile system) for spinal PRO. We hypothesized that this system may improve the quality of care in an outpatient clinic. PURPOSE: This study aimed to analyze the patient-reported efficacy of a mobile system through a survey of patients' responses compared with a paper system. STUDY DESIGN/SETTING: A prospective observational study was carried out. PATIENT SAMPLE: Surveys were conducted for 103 patients who had experience using both the paper and electronic systems in the outpatient clinic. OUTCOME MEASURES: Patient-reported positive response score (PRS) was the outcome measure. METHODS: The survey included the characteristics of the patients (sex, age, use of smartphone, familiarity with smartphone applications, proficiency of typing with mobile device, site of pain, and education level) and eight questions in four domains: (1) efficacy in the waiting room, (2) efficacy during the clinic visit, (3) overall satisfaction, and (4) opinion about the use of this system. The response to each question was scored from 1 to 5 (1, negative; 5, positive response). The patient-reported PRS was calculated by adding the scores of the 8 questions and converting the total range to 0-100 (60, neutral). RESULTS: The mean PRS of the 8 questions was 79.8 (95% CI, 76.7-83.9). The mean PRS was 78.9 (75.6-82.2) at the waiting room and was 80.5 (77.1-83.9) during the clinic. The PRS for overall satisfaction and use of this system were 83.3 (79.6-87.0) and 77.1 (71.9-82.3), respectively. The use of smartphones and the proficiency of typing were independently significant predictors of PRS with an R(2) value of 0.325. CONCLUSIONS: The mobile device-based system improved the patient-reported efficacy in spine outpatient clinics. However, various factors such as the use of smartphones need to be considered when developing and applying mobile systems.

Anger, anger expression, cardiovascular risk factors, and gastrointestinal symptoms by hwa-byung symptoms in Korean adult women.

PURPOSE: This study explored relationships of anger and anger expression to cardiovascular (CV) risk factors and gastrointestinal (GI) symptoms in Korean women based on hwa-byung (HB) symptoms. METHODS: A descriptive, comparative design was used. One-hundred four women who are from 20 to 65years old were recruited. Based on the HB score, 22 women indicated for HB and the rest were classified as normal. Data collection was done with several questionnaires including HB symptom scale, state-trait anger expression inventory, and GI symptom questionnaire and clinical information. RESULTS: Women with HB demonstrated significantly higher levels of trait anger and dysfunctional anger expression such as anger suppression and anger expression than normal group. Although blood pressure was higher in women with HB, the differences were not significant. Self-report of GI symptoms were significantly more in women with HB, however no significant difference was found in gastroscopy results. CONCLUSIONS: Women with HB were younger and might lack of sufficient social support. This study suggests relationship of anger and anger expression to functional GI symptoms. Characteristics of women with HB should be considered in developing intervention programs for healthy coping. Future studies need more women with HB for better comparison.

Reliability and validity of the Menopausal Symptom Scale.

Menopausal symptom experiences differ by racial/ethnic group. Thus, health care professionals who use instruments to measure menopausal symptoms need to be aware of cultural sensitivities. The purpose of this study was to examine the psychometric properties of the Menopausal Symptom Scale among Korean women. Data from 229 Korean women between the ages of 40 and 65 years, selected by convenience sampling, were collected during 2010-2011. Psychometric properties were evaluated through content validity and item analysis, construct validity, discriminant validity, criterion-related validity, floor/ceiling effects, and internal consistency reliability. Exploratory and confirmatory factor analyses revealed four factors explaining 65% of variance in the items. Discriminant validity and the criterion-related validity were supported. No significant floor/ceiling effects were found. Cronbach's alpha values ranged from 0.90 to 0.95. The Menopausal Symptom Scale developed for Korean menopausal women appeared to be a valid and reliable instrument. It appeared that it measured psychological symptoms more comprehensively and in a culturally-specific or ethnic-specific manner in menopausal women of Asian or traditional cultures. It will be necessary to broaden the scale of research to other ethnic groups and countries to verify the psychometric properties specific to the ethnic group or country.

[Bone mineral density, biochemical bone turnover markers and factors associated with bone health in young Korean women].

PURPOSE: This study was done to assess the bone mineral density (BMD), biochemical bone turnover markers (BTMs), and factors associated with bone health in young Korean women. METHODS: Participants were 1,298 women, ages 18-29, recruited in Korea. Measurements were BMD by calcaneus quantitative ultrasound, BTMs for Calcium, Phosphorus, Osteocalcin, and C-telopeptide cross-links (CTX), body composition by physical measurements, nutrients by food frequency questionnaire and psychosocial factors associated with bone health by self-report. RESULTS: The mean BMD (Z-score) was -0.94. 8.7% women had lower BMD (Z-score≤-2) and 14.3% women had higher BMD (Z-score≥0) than women of same age. BTMs were not significantly different between high-BMD (Z-score≥0) and low-BMD (Z-score<0) women. However, Osteocalcin and CTX were higher in women preferring caffeine intake, sedentary lifestyle and alcoholic drinks. Body composition and Calcium intake were significantly higher in high-BMD. Low-BMD women reported significantly higher susceptibility and barriers to exercise in health beliefs, lower bone health self-efficacy and promoting behaviors. CONCLUSION: Results of this study indicate that bone health of young Korean women is not good. Development of diverse strategies to intervene in factors such as exercise, nutrients, self-efficacy, health beliefs and behaviors, shown to be important, are needed to improve bone health.

Comparison of quality of life measures in Korean menopausal women.

The psychometric properties of two menopause-specific quality of life (QoL) measures, the Menopausal Quality of Life (MQOL), and the Women's Health Questionnaire (WHQ), were evaluated and compared in a convenience sample of 304 Korean women in menopausal transition. Data were collected with a self-report questionnaire. Evaluation of validity included factor analysis, convergent and discriminant validity, and known-groups validity. Evaluation of reliability included internal consistency reliability and item analysis. The results indicated that both QoL instruments were valid, but the WHQ was more internally consistent in measuring QoL although with a factor structure different from previous research. Replication studies to identify factor structures are needed for both measures.

Measurement of quality of life in menopausal women: a systematic review.

Use of a wide variety of quality of life (QoL) instruments, each measuring a different aspect of menopause with a different type of underlying scale, has been a major problem in menopause research. The aim of this review was to identify instruments developed for menopausal women and evaluate the psychometric properties and appropriateness of instruments for the study of QoL in menopausal women. Seven measures from 16 papers were chosen for the review. The psychometric evaluations were conducted based on quality judgment criteria. Of the seven measures reviewed in this study, the psychometric quality scores of Women's Health Questionnaire (WHQ) was the highest. However, the result indicates that most instruments of menopause-specific QoL need further testing and evaluation of the various aspects of their psychometric properties. In addition, future research assessing psychometric properties with cross-cultural samples may be beneficial in adapting measures to specific context and study populations.

[Depression status of academic high school students in Seoul: mediating role of entrapment].

PURPOSE: Purpose of this study was to investigate the status of depression in academic high school students and path analysis model for exploring the mediating role of entrapment to depression in relation to academic stress and perceived social support. METHODS: Measurements were four reliable questionnaires measuring academic stress, social support, entrapment, and depression. Data were collected from students in 17 high schools in Seoul. RESULTS: Students (n=5,346) completing the questionnaires indicated depression & entrapment from academic stress. Depression was more prevalent in girls, those whose parents' household income was less than two million won, who did not live with father or mother or both due to divorce, separation, or death, and those who smoked or used alcohol. Entrapment was more prevalent in students similar to cases of depression and in seniors. According to the proposed path model, 48.6% of depression was explained by academic stress, social support, and entrapment. The indirect effect of entrapment as a mediator between academic stress and depression was verified and larger than the direct effect of academic stress on depression. CONCLUSION: Considering levels of depression and entrapment demonstrated by these students, better mental health programs with diverse strategies should be developed for their psychological well-being.

Anger, anger expression, and suicidal ideation in Korean adolescents.

This study described the levels of anger, anger expression, and suicidal ideation in Korean adolescents. Data from 18,752 adolescents were collected using a self-report questionnaire. Anger, anger expression, and suicidal ideation exhibited significant differences according to school level and gender. The group with higher anger and anger expression showed a higher average suicidal ideation score than that of the group with lower anger and anger expression, suggesting that school-based programs which alleviate anger may be needed to decrease suicidal ideation among Korean adolescents.

Suicidal ideation in adolescents: an explanatory model using LISREL.

Suicidal ideation has been reported to be a major factor in attempted and completed suicides. The purpose of this study is to test a structural model to explain adolescent suicidal ideation. Specifically tested is the relationship between the predictor variables of trait anger, anger suppression, entrapment, psychosomatic symptoms, depression, and resilience and the dependent variable of suicidal ideation. Data are collected from a convenience sample of 11,393 students from 36 middle schools and 23 high schools in Korea. Trait anger, entrapment, psychosomatic symptoms, depression, and resilience have a direct effect on suicidal ideation whereas anger suppression shows a significant indirect effect on adolescent suicidal ideation. The predictor variables account for 39% of the variance in suicidal ideation. The study findings suggest that future programs for prevention or alleviation of adolescents' suicidal ideation need to use interventions that facilitate their resilience and reduce their anger, entrapment feeling, psychosomatic symptoms, and depression.

Maternal sensitivity: a concept analysis.

AIM: The aim of this paper is to report a concept analysis of maternal sensitivity. BACKGROUND: Maternal sensitivity is a broad concept encompassing a variety of interrelated affective and behavioural caregiving attributes. It is used interchangeably with the terms maternal responsiveness or maternal competency, with no consistency of use. There is a need to clarify the concept of maternal sensitivity for research and practice. DATA SOURCES: A search was performed on the CINAHL and Ovid MEDLINE databases using 'maternal sensitivity', 'maternal responsiveness' and 'sensitive mothering' as key words. The searches yielded 54 records for the years 1981-2007. Rodgers' method of evolutionary concept analysis was used to analyse the material. FINDINGS: Four critical attributes of maternal sensitivity were identified: (a) dynamic process involving maternal abilities; (b) reciprocal give-and-take with the infant; (c) contingency on the infant's behaviour and (d) quality of maternal behaviours. Maternal identity and infant's needs and cues are antecedents for these attributes. The consequences are infant's comfort, mother-infant attachment and infant development. In addition, three positive affecting factors (social support, maternal-foetal attachment and high self-esteem) and three negative affecting factors (maternal depression, maternal stress and maternal anxiety) were identified. CONCLUSION: A clear understanding of the concept of maternal sensitivity could be useful for developing ways to enhance maternal sensitivity and to maximize the developmental potential of infants. Knowledge of the attributes of maternal sensitivity identified in this concept analysis may be helpful for constructing measuring items or dimensions.

A comparison of two pain measures for Asian American cancer patients.

Although two of the most commonly used multidimensional pain scales are the McGill Pain Questionnaire-Short Form (MPQ-SF) and the Brief Pain Inventory-Short Form (BPI-SF), little psychometric analysis of these tools has been done among ethnic minority populations. This study evaluates and compares psychometric properties of these scales among 119 Asian American cancer patients. Cronbach's alphas of the MPQ-SF and BPI-SF are high (alpha = .85 to .97). Correlation coefficients of the item analyses are .12 to .88 for the MPQ-SF and .44 to .90 for the BPI-SF. Two factors are extracted for both instruments. Correlations between pain scores and the usage of pain medications are low for the MPQ-SF ( r = .23 to .33) and moderate for the BPI-SF (r = .40 to .42). Results indicate that among Asian Americans, both pain scales are internally consistent, some items in each are redundant, and the BPI-SF is more valid than the MPQ-SF.

Gender and ethnic differences in cancer patients' needs for help: an Internet survey.

BACKGROUND: Although a number of studies have reported different domains of cancer patients' needs for help, very little is known about gender and ethnic differences in those needs. Gender differences have been implicitly assumed in most studies, and specific ethnic groups have been focused on rather than comparing several ethnic groups. OBJECTIVES: The purpose of this pilot study was to explore cancer patients' needs for help among four major ethnic groups in the US, to determine gender and ethnic differences in needs, and to provide direction for future studies. DESIGN: This was a descriptive and comparative pilot study using a feminist perspective. SETTINGS AND PARTICIPANTS: A total of 110 self-identified cancer patients were recruited through both Internet and community settings using a convenience sampling method. METHODS: The instruments included sociodemographic questions, the Cancer Needs Questionnaire-Short Form, and the Supportive Care Needs Survey. The data were analyzed using descriptive statistics and inferential statistics including the Mann-Whitney U tests and Kruskal-Wallis tests. RESULTS: The findings indicated that there was no significant gender difference in all domains of needs for help. There were significant ethnic differences in all domains of needs except communication and sexual needs. Asians reported the lowest scores in most domains of needs for help while Hispanics reported the highest scores in most domains of needs for help. CONCLUSIONS: The findings indicated certain ethnic differences in cancer patients' needs for help and suggest further in-depth qualitative investigations on cultural beliefs and attitudes that may influence needs, with a careful examination of gender sensitivity and cultural competence of the instruments measuring cancer patients' needs for help.