Effectiveness of a Strength-Based Intervention into Nursing Education in South Korea.

Purpose: This study aimed to examine the effectiveness of strength-based interventions integrated into the nursing education. Materials and Methods: The participants were 259 baccalaureate nursing students in South Korea. Over 15 weeks, strength-based intervention was integrated into the regular nursing curriculum. Stress, resilience, and well-being of the participants were measured before and after the intervention. The data were analyzed using a linear mixed model via the SPSS statistics 21.0. program. Results: There was a negative weak association between stress and well-being and between stress and resilience (r = -0.164, p = 0.009 and r = -0.138, p = 0.029, respectively) and a positive moderate association between well-being and resilience (r = 0.561, p<0.001). After adjusting the covariates, the interaction of group*time for stress and resilience were significant after the intervention, reflecting a higher status of stress and improved resilience. (p= 0.046 and 0.030 respectively). Conclusion: Integrating strength-based interventions into the nursing curriculum was effective in improving the mental health of Korean nursing students. Future research is needed to identify various ways of applying positive psychology to the nursing education.

Prevalence of liver cirrhosis based on the metabolic health and weight criteria: Report from the Korea National Health and Nutrition Examination Survey (KNHANES) data analysis.

INTRODUCTION AND OBJECTIVES: Recent studies have proposed two distinctive types of obesity, metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO), based on various physiological factors. This study sought to explore the relationship between the metabolic obesity types and the incidence of liver cirrhosis (LC) in a large nationally-representative population. MATERIALS AND METHODS: Data on 27,629 adults with MHO or MUHO, were analyzed from the Korea National Health and Nutrition Examination Survey (KNHANES) obtained from 2015 through 2019. Four categories of metabolic health and weight (MHW) were generated for analysis: (1) MHO, (2) MUHO, (3) Metabolically unhealthy normal weight (MUHNW), and (4) Metabolically healthy normal weight (MHNW). Statistical analyzes were performed with univariate and multivariate logistic regression. RESULTS: The prevalence of LC did not show statistically significant differences among the MHW categories: 0.5% in MHO, 0.4% in MUHO, 0.2% in MHNW, and 0.3% in MUHNW. The unadjusted analysis showed a significant association between self-reported LC and MUHO, but this association was not evident in the adjusted analysis. In the adjusted analysis of the prevalence of laboratory LC, a significant association emerged in the MUHO group, followed in descending order of magnitude by the MHO and MUHNW groups. A favorable fasting blood glucose level was the only factor associated with increased prevalence of reported LC in MUHO. CONCLUSIONS: The study demonstrated a difference in the prevalence of LC between MHO and MUHO. Our study concludes that the MHO phenotype is a transient status with regard to metabolic abnormalities, and caution is necessary when evaluating MHO.

Changes in Physical Activity, Healthy Diet, and Sleeping Time during the COVID-19 Pandemic in South Korea.

The coronavirus disease 2019 (COVID-19) pandemic and subsequent social distancing orders may have changed health behaviors adversely. This study aims to examine changes in physical activity, diet, and sleep patterns during the pandemic in South Korea and to identify the factors influencing adverse changes in these behavioral indicators. Data from the Community Health Survey conducted in 2020 with a total of 229,269 adults were used, employing multivariate logistic regression and a classification and regression tree model. Participants reported decreased physical activity (49.6%), an increase in unhealthy diet (17.0%), and decreased sleep time (9.4%). Changes in adverse health behaviors were significantly related to being female, being in poor subjective health, not having hypertension or diabetes, engaging in other unhealthy behaviors, and complying with COVID-19 prevention guidelines. While those with adverse physical activity and unhealthy diet changes were younger and concerned about COVID-19 infection, the participants with adverse sleep changes were older, experienced economic stress (unemployed or recipients of basic living benefits), and had other unhealthy behaviors (obesity, severe stress, current smoking, and binge alcohol consumption). Public health efforts to intervene in these adverse health behaviors during the COVID-19 pandemic should target the variables shown to be significant in this study.

Weight control behaviors associated with early menopause among Korean women.

This study investigated weight control behaviors associated with early menopause among Korean women, utilizing cross-sectional Korean National Health and Nutrition Examination Survey (KNHANES) data obtained from 2014 to 2018 to analyze 3,591 women aged 20-64 years with complete responses to questions dealing with natural menopause status and age. The data were analyzed using multivariate ordinal logistic regression. After adjusting for confounding variables affecting weight control behaviors and the timing of menopause, not having lost weight (odds ratio [OR] = 0.69, 95% confidence interval [CI] = 0.50-0.97, p = .033) and less use of reducing and controlling food for weight control (OR = 0.67, 95% CI = 0.55-0.81, p < .001) were shown to be associated with earlier menopause. In a further analysis, higher fat intake and lower monounsaturated fatty acid intake were associated with earlier menopause (OR = 1.06, 95% CI = 1.02-1.11, p = .007; OR = 0.94, 95% CI = 0.89-0.99, p = .014, respectively). This study findings are applicable in policies or interventions aiming to prevent cardiovascular risks among those with different timing of menopause and possibly delay early menopause.

The effects of weight fluctuation on the components of metabolic syndrome: a 16-year prospective cohort study in South Korea.

BACKGROUND: Weight fluctuation (WF) is highly prevalent in parallel with the high prevalence of intentional or unintentional dieting. The health risks of frequent WF for metabolic syndrome (MS) have become a public health concern, especially for health care providers who supervise dieting as an intervention to prevent obesity-related morbidity or to improve health, as well as for the general population for whom dieting is of interest. The aim of this study was to investigate the long-term effect of WF on the risk of MS in Koreans. METHODS: This study analyzed secondary data from the Korean Genome and Epidemiology Study, a 16-year prospective cohort study, on 8150 individuals using time-dependent Cox regression. RESULTS: WF did not increase the risk of MS in either normal-weight or obese subjects. In an analysis of the components of MS, greater WF significantly increased the risk of abdominal obesity (HR = 1.05, 95% CI = 1.02-1.07, p < 0.001) in normal-weight individuals. However, WF did not increase the risk of hyperglycemia, low high-density lipoprotein cholesterol levels, elevated blood pressure, or raised fasting glucose in normal-weight individuals, and it did not influence any of the components of MS in obese individuals. CONCLUSION: Since WF was found to be a risk factor for abdominal obesity, which is the most reliable predictor of MS, it should be considered when addressing weight control. Further studies on cut-off points for the degree of weight loss in a certain period need to be conducted to help clinicians provide guidance on appropriate weight control.

The Impacts of Weight Change and Weight Change Intention on Health-Related Quality of Life in the Korean Elderly.

Objective: This study aimed to identify the impacts of weight change and weight change intention on health-related quality of life (HRQL) among community-dwelling Korean elderly individuals. Method: Data on those aged 75 years and above from the Korean National Health and Nutrition Examination Survey were analyzed using multiple regression analysis. Results: Compared with no weight change, unintentional weight loss was associated with significantly lower adjusted overall HRQL and lower scores in the subdimensions of mobility, pain/discomfort, usual activities, and self-care (in order), whereas intentional weight loss was associated with significantly poorer scores for anxiety/depression. Weight gain showed no statistically significant differences in comparison with no weight change. Discussion: These findings suggest that weight maintenance or weight gain should be recommended rather than weight loss, whether unintentional or intentional, regardless of weight status, to improve HRQL among the elderly.

Perceptual body image and the relationship with weight control across the adult lifespan by sex in Koreans.

Background: This study aimed to investigate perceptual body image and the relationship between perceived body image (PBI) and weight control differentiated according to obesity categories across the adult lifespan by sex among Koreans. Methods: We analyzed data on 10 198 adults aged 25 or older from the Korean National Health and Nutrition Examination Survey of a nationally representative sample of non-institutionalized Koreans. Results: Significant discordance between PBI and body mass index (BMI) or waist circumference (WC) was found in all age groups in both sexes, and the discordance for obesity grew more severe with age. Linear associations between PBI and BMI or WC were found in normal weight and obese groups in all age groups in both sexes, with relatively greater BMI or WC differences for PBI found in obese men aged ≤64 or ≤44, respectively, and obese women of all ages or aged ≥75, respectively, compared to normal weight. Obese women aged ≥65 (BMI) or ≥75 (WC) and obese men in the 45-54 and 65-74 age groups (BMI and WC) had significant association between PBI and weight control. Conclusions: Interventions regarding accurate body size perception should be prioritized for obese women aged ≥65 or ≥75 and for obese men aged 45-54 and 65-74.

Health Behaviors and Academic Performance Among Korean Adolescents.

PURPOSE: This study aimed to examine the most prominent health-related behaviors impacting the academic performance of Korean adolescents. METHODS: The 2012 Korea Youth Risk Behavior Web-Based Survey data were analyzed using an ordinal regression analysis after adjusting for general and other health behaviors. RESULTS: Before adjustment, all health behaviors were significantly associated with academic performance. After adjustment for other health behaviors and confounding factors, only smoking [odds ratio (OR) = 2.07, 95% confidence interval (CI) (1.98, 2.16), p < .001], alcohol consumption [OR = 1.22, 95% CI (1.18, 1.27), p < .001], and physical activity [OR = 1.09, 95% CI (1.06, 1.13), p < .001] were associated with lower academic performance, and engaging in a regular diet [OR = 0.65, 95% CI (0.65, 0.62), p < .001] was associated with higher academic performance. CONCLUSIONS: Regular diet, reducing smoking and alcohol drinking, and physical activity should be the target when designing health interventions for improving academic performance in Korean adolescents.

Factors Associated with Early Smoking Initiation among Korean Adolescents.

PURPOSE: The aim of this study was to identify factors associated with early initiation of cigarette smoking among Korean adolescents. METHODS: A secondary analysis was conducted on the 2012 Korea Youth Risk Behavior Web-based Survey data using Cox proportional hazards regression. RESULTS: Early smoking initiation was associated with being male, having a positive subjective health status, perceiving oneself as thin or average weight (body image), having an average happiness level, being stressed, consuming alcohol, having suicidal ideation, experiencing sexual intercourse, having low or average academic grades, having a parental education level of high school or below, not taking a family trip in the previous 12 months, and having a family that approves of smoking in the home. CONCLUSIONS: Interventions targeting the prevention of smoking initiation among adolescents should include individual factors such as health status, body weight, perceived mental health status, health-risk behaviors, and academic characteristics as well as family factors that reinforce family cohesion and home smoking bans. Moreover, male adolescents aged 12-13 years and their parents should be the main target of these interventions.

Waist circumference cutoff points for central obesity in the Korean elderly population.

The aim is to determine the appropriate cutoff values of waist circumference (WC) for an increased risk of the metabolic syndrome in the Korean elderly population. We analyzed the WC cutoff values of four groups divided according to sex and age with a total of 2,224 elderly participants aged 65 years old and above from the Fourth Korean National Health and Nutrition Examination Survey using the receiver operating characteristic curve and multiple logistic regression. The WC cutoff values associated with an increased risk of metabolic syndrome were 89.6 cm for men and 90.5 cm for women for those who were 65 to 74 years old, and 89.9 cm for men and 87.9 cm for women for those who were 75 years old or older. WC cutoff points for estimating metabolic risk are similar in elderly men and women. Age-specific optimal WC cutoff points should be considered especially for elderly women in screening for metabolic syndrome.

Cardiovascular disease risk factors associated with depression among Korean adults with coronary artery disease and cerebrovascular disease.

OBJECTIVE: This study investigated the cardiovascular risk factors associated with depression among Korean adults with coronary artery disease (CAD) and cerebrovascular disease (CBVD). METHODS: A total of 487 coronary artery disease and 434 cerebrovascular disease subjects from the Fourth Korean National Health and Nutrition Examination Survey were analyzed according to sex using multiple logistic regression. RESULTS: The prevalence of depression was 21.7% in those with CAD and 25.5% in those with CBVD. The associated risk factors for depression were female sex (odds ratio [OR] 15.77; 95% confidence interval [CI], 2.44-102.03, P = 0.004), less education (OR 7.09 and 10.36, 95% CI, 1.24-40.75, 1.86-57.70 for an elementary and middle school education, respectively), and hypertension (OR 5.35; 95% CI, 1.48-19.40) in those with CAD and were female sex (OR 4.06, 95% CI, 1.12-14.76) and diabetes mellitus (OR 3.31, 95% CI, 1.36-8.05) in CBVD. These significant associations remained in males, but not in females in those with both CAD and CBVD. CONCLUSIONS: This study found the associations between hypertension and depression in those with CAD and diabetes mellitus and depression in those with CBVD in males, but not in females. Further studies are needed to explore the associated psychosocial factors of depression in those with different CAD kinds in females.

Waist circumference and health-related quality of life by sex in the Korean elderly.

OBJECTIVE: This study aims to explore the impact of differential degrees of obesity on health-related quality of life (HRQL) by sex in the Korean elderly. METHOD: We analyzed data on those aged between 65 and 74 years from the Korean National Health and Nutrition Examination Survey (KNHANES) using multiple regression analysis. RESULTS: Compared with the lowest waist circumference (WC) quintile, the women in the fourth and fifth quintiles demonstrated significantly lower unadjusted HRQL but not the men in any quintiles. Whereas higher WC quintiles impaired mobility, usual activities, and pain/discomfort in women, the fourth WC quintile improved usual activities in men. After adjustment, only the women of the highest WC quintile reported impaired mobility. DISCUSSION: Extreme obesity worsens mobility, and comorbidity in combination with obesity worsens HRQL in elderly women. Monitoring and controlling comorbidity and maintaining adequate WC decreases the risks of lowered HRQL in Korean elderly women.

Impact of hypertension-related comorbidity on health-related quality of life: a population-based survey in South Korea.

The aim of this study was to examine the impact of the most prevalent comorbid chronic diseases in hypertensives on health-related quality of life (HRQOL) in the general representative Korean population using the EuroQOL-5D (EQ-5D) and to assess this impact by sex and after controlling for sociodemographic factors. The effects of hypertension and comorbidity on HRQOL were examined using multiple linear regression models with Fourth Korean National Health and Nutrition Examination Survey data. In a total of 5736 adults, the prevalence of hypertension alone was 20.8%, and the prevalence rates of hypertension comorbid with diabetes mellitus (DM), cardiovascular disease (CVD), and musculoskeletal (MS) disease were 9.5%, 3.8%, and 33.5%, respectively. Females with hypertension and other comorbidity showed worse HRQOL scores, with the exception of hypertension and CVD, where males scored worse for HRQOL. After adjustment, subjects with comorbid DM, CVD, or MS experienced EQ-5D scores decreasing by 0.01, 0.09, and 0.05, respectively. Since comorbidity impairs HRQOL in hypertensives, health providers should consider comorbid diseases in hypertensives when developing methods of intervention to effectively manage hypertension.

Suicidal ideation and associated factors by sex in Korean adults: a population-based cross-sectional survey.

OBJECTIVE: This study investigates suicidal ideation and its associated factors by sex in Korean adults, focusing on health behaviors and health status. METHODS: Cross-sectional data of 6,969 adults (25-64 years) who completed the Fourth Korean National Health and Nutrition Examination Survey were analyzed. RESULTS: In both sexes, those who were married, had higher educational attainment or were non-smokers experienced low stress and had good self-rated health showed lower suicidal ideation. Significant factors were age for men and subjective body image and sleep time for women. In men, those aged 45-54 years showed the highest suicidal ideation rate. The effects of stress and depression on suicidal ideation were higher in men than in women. CONCLUSIONS: The development of a suicide prevention program for Korean adults requires different approaches for each sex. For working men aged 45-54 years, it should focus on the management of work-related stress and depression. For women, it should be a community support program for those who are less educated, have no job or experience a great deal of stress and depression.

Relationship Between Health-related Behavioral and Psychological Factors and Cardiovascular and Cerebrovascular Diseases Comorbidity Among Korean Adults With Diabetes.

PURPOSE: This study aims to explore the relationships between health-related behavioral and psychological factors and cardiovascular and cerebrovascular diseases (CCVD) comorbidities among Korean adults with diabetes mellitus (DM). METHODS: Data included in the Fourth Korean National Health and Nutrition Examination Survey were used. This study compared three groups: those diagnosed with DM only, DM and hypertension, DM, hypertension and CCVD using multinomial logistic regression analyses and the classification and regression tree (CART) model. RESULTS: Weight control (OR = 4.01) and depression (OR = 2.37) are related with increased odds of having hypertension and CCVD comorbidity in those with DM. The CART model suggested that the high prevalence risk groups for hypertension or CCVD comorbidities were diabetic adults aged between 51 and 69 with a body mass index of 25 and above and those aged 70 and above. CONCLUSION: For effective control of CCVD comorbidities among diabetic Korean adults, psychological support for depression and weight control need to be prioritized when managing DM. Weight control intervention needs to be reinforced for DM patients aged between 51 and 69 and that even if BMI is below 25, the occurrence of comorbidities needs to be carefully monitored for DM patients aged 70 or older.