Acceptance of and hesitancy about COVID-19 vaccination among nursing students in clinical practice.

BACKGROUND: Although vaccination of nursing students in clinical practice is important due to the possibility of COVID-19 infection and subsequent transmission to patients, some nursing students are hesitant to get vaccinated. Thus, it is necessary to identify the actual intentions and motivations of nursing students who have been vaccinated for COVID-19, even if their decisions were driven by clinical practice policy. The purpose of this study was to understand the nature of COVID-19 vaccine hesitancy among vaccinated nursing students in clinical practice and to examine their reasons for getting vaccinated despite such hesitancy. METHOD: A cross-sectional, descriptive study was conducted at two tertiary hospitals in South Korea from November 20, 2021, to December 17, 2021. The study recruited a convenience sample of 125 nursing students who were vaccinated for COVID-19. Data were analyzed using the chi-square test, Fisher's exact test, and independent t-test. RESULTS: Of the 125 nursing students, 51 (40.8%) reported vaccine hesitancy, among whom 88.2% reported that their hesitancy was due to the adverse effects and instability of the vaccine. It was also found that 70.6% of nursing students in the vaccine-hesitant group were eventually vaccinated due to clinical practice policy, whereas 67.6% of nursing students in the non-hesitant group were vaccinated to protect their health. CONCLUSIONS: COVID-19 vaccine hesitancy is prevalent among nursing students. Therefore, specific efforts should be made to provide education focusing on the safety, benefits, and efficacy of COVID-19 vaccines, implement mandatory vaccination policies for clinical practice, and give priority to vaccination opportunities to nursing students in order to reduce the hesitancy of nursing students to vaccines.

Effectiveness of an enhanced simultaneous cognitive-physical dual-task training based on fairy tales (ESCARF) in older adults with mild cognitive impairment.

The aim of this study was to provide a dual-task program that included cognitive and physical training to older adults with mild cognitive impairment (MCI) and evaluate its effects. A single-group pretest-posttest design was performed using 15 older adults with MCI. A 12-week enhanced simultaneous cognitive-physical dual-task training based on fairy tales (ESCARF) program was conducted from September 2019 to December 2019. Participants were assessed using the Korean version of the Montreal Cognitive Assessment, electroencephalography (EEG), muscle strength, flexibility, agility, memory self-efficacy questionnaire, physical self-efficacy scale, and quality of life before and after 6 and 12 weeks of the intervention. The ESCARF program significantly improved cognitive function, physical function, self-efficacy, and quality of life in older adults with MCI. These findings will provide insights into the development and implementation of customized cognitive interventions to prevent or delay the onset of cognitive decline in older adults with MCI.

Development of a Web-Based Alcohol Prevention Program Linking School-Child-Family for Intermediate Elementary Students.

Family strongly influences student health behavior. However, alcohol-preventive education programs that link parents and school for intermediate-elementary school students remain scarce. Although online educational programs constitute effective interventions to intentionally improve health behaviors, traditional methods are used to implement alcohol- prevention programs for students. In this study, we aimed to (1) develop an online school-child-family alcohol-prevention program based on the theory of planned behavior and (2) examine the preliminary effects of the program on intention to consume alcohol among intermediate-elementary school students. This single-group, pre- and posttest study enrolled 46 Grade 3 students from a public elementary school in a metropolitan South Korea city and ascertained the preliminary effects of a 5-week online alcohol-prevention program by using the alcohol drinking prevention behavior scale. Attitudes, perceived behavioral control, and intention of alcohol-preventive behaviors significantly improved (p < .05) whereas subjective norms did not. The online alcohol-prevention program based on the theory of planned behavior and school-child-family linkage beneficially influenced intention, attitude, and perceived behavioral control for alcohol-prevention behavior, and the effectiveness and convenience of this program underscores its potential application as an educational intervention to improve health behaviors of intermediate-elementary school students.

The Relationship Between Duration of Stay and Self-rated Health Among International College Students in South Korea.

This study examined relationships between duration of stay and self-rated health among international students in South Korea and compared participants' health-related characteristics according to duration of stay. The study recruited a convenience sample of 165 international students enrolled in undergraduate or graduate programs. For this cross-sectional, descriptive study, participants were recruited at one South Korean university. Data were subjected to ordinal logistic regression analyses. After controlling for covariates, a stay of 6 months or less was a significant predictor of better self-rated health. Compared to those in their first semester, international students staying more than 6 months more frequently experienced short sleep duration, physical health symptoms, healthcare utilization, unmet healthcare needs, and perceived discrimination. Study findings indicate that international students' health tends to deteriorate after their first semester. To promote the health and academic success of international students, universities should provide timely health promotion programs.

The Moderating Effects of Accurate Expectations of Lethality in the Relationships between Suicide Intent and Medical Lethality on Suicide Attempts.

OBJECTIVE: The purpose of this study was to explore the accuracy of expectation of medical lethality and to identify characteristics related to high medical lethality in suicide attempters. METHODS: A total of 370 suicide attempters (173 men, 197 women) who visited the emergency department at one university hospital were interviewed. RESULTS: Using the Lethality Scale, 103 (27.8%), 114 (30.8%), and 153 (41.4%) suicide attempters were assigned to the low, medium, and high medical lethality groups, respectively. The medium and high medical lethality groups were older, and reported poorer socioenvironmental conditions, compared with the low lethality group. Higher levels of suicide intent were associated with more lethal attempts but only for those attempters who had accurate expectations of the medical lethality of their attempts. CONCLUSION: The accuracy of expectations about the likelihood of dying was found to moderate the relationships between suicide intent and medical lethality.

Survival and medical costs of melanoma patients with subsequent cancer diagnoses: A South Korean population-based retrospective cohort study.

AIM: Subsequent cancers (SCs) after melanoma diagnosis further increases the risks of mortality and medical costs. This population-based analysis aimed to evaluate risk factors for SC, mortality, and medical costs of melanoma patients with SC. METHODS: A retrospective cohort analysis was conducted using a nationwide claims database during 2002-2017 in South Korea. SC was defined as having other types of cancer diagnoses other than subsequent melanoma during-up to 5 years after melanoma diagnosis. Melanoma patients were divided into patients with and without SC, and the overall and subgroup survival rates, the risk of developing SC, and the total medical costs were analyzed using a Kaplan-Meier method and regressions. RESULTS: A total of 3740 melanoma patients were included in the analysis (mean age, 62.3 ± 15.4 y; 47.2% men), and 2273 patients (1157 within 2 months, 756 after 2 months of melanoma diagnosis) had SC. Higher Charlson comorbidity index score and male sex significantly increased the risk of developing SC. Five-year survival rate and cumulative medical costs were 62.3% (95% confidence interval [CI], 60.8-63.9) and $21,413, respectively, in all patients. Patients with SC diagnosed after 2 months showed the lowest survival rate of 47.8% (95% CI, 44.3-51.4) and the highest costs of $27,081, showing a mortality hazard ratio of 1.65 (range, 1.46-1.86) and a cost ratio of 1.189 (range, 1.112-1.271) compared with those without SC. CONCLUSION: This study presented survival outcomes and medical costs in melanoma patients and confirmed that SC after the first diagnosis of melanoma significantly increased disease burden in terms of mortality and medical costs.

Factors influencing the initiation and adherence of LTBI treatment in healthcare workers: a systematic review.

Despite the importance of latent tuberculosis infection (LTBI) treatment and management in healthcare workers (HCWs), only a few studies have provided a comprehensive review of factors associated with the success rate of each stage of the LTBI treatment, as well as strategies to improve treatment adherence. This study investigated factors and determinants of patient losses at each stage of the entire cascade of LTBI in HCWs. Studies were extracted from PubMed, EBSCOhost, EMBASE, Cochrane Library, and ScienceDirect. Our study found poor completion rates of LTBI treatment in HCWs. The main reason for not visiting the outpatient clinic or not accepting treatment was related to the demographic characteristics, whereas adverse drug effects were the main reason for treatment discontinuation. These findings suggest that tailored interventions must be developed to improve the success rate at each stage of the LTBI treatment in HCWs.

Simultaneous cognitive-physical dual task training based on fairy tales in older adults with mild cognitive impairment: A pilot study.

In this study, we aimed to develop a simultaneous cognitive-physical dual-task training program based on familiar cultural backgrounds using fairy tales and to explore its feasibility and preliminary effects, including effects on neurophysiological, cognitive, and physical functions. A single-group pretest-posttest design (n = 9) was employed to evaluate the effects of the cognitive-physical intervention performed for 60-90 min once a week for 12 weeks. The findings showed that perceived memory and physical self-efficacy, muscle strength, and cognitive function were significantly increased after the intervention. Although the relative beta band power measured using electroencephalography showed a tendency to increase in eight brain domains after the 12-week intervention, the changes were not significant. Findings suggested that the intervention was feasible and provided beneficial effects on cognitive and physical functions in older adults with mild cognitive impairment. Future research on larger sample sizes using randomized controlled trials is needed to determine the effectiveness of such interventions on neurophysiological functions.

Screening and Vaccination Against Measles and Varicella Among Health Care Workers: A Cost-effectiveness Analysis.

The aim of this study was to examine the most cost-effective strategy of screening and vaccinating measles- and varicella-susceptible health care workers (HCWs). A retrospective cost-effectiveness analysis was conducted at a tertiary hospital in Korea with 300 HCWs who were at high risk of infection. Self-reported histories of vaccinations, infectious diseases, and contact with such cases were collected. Serological tests for immunoglobulin G titers of measles and varicella were performed. Data were analyzed using analysis of variance, Kruskal-Wallis test, χ2 test, and Fisher exact test. Seropositivity rates were 96.3% for measles and 95.7% for varicella. Four different strategies (cases) for vaccination were investigated. Considering the progressive decline in antibody concentrations and the false-positive responses in self-reported histories, case 3, which involved administering 2-dose vaccinations to susceptible HCWs demonstrated by antibody screening tests for both measles and varicella, was the most cost-effective strategy. Health care facilities should establish mandatory immunization policies that reduce the risk of transmission of vaccine-preventable diseases.

Association between Maternal Adverse Childhood Experiences and Risk of Post-traumatic Stress Disorder in the Offspring.

OBJECTIVES: Adverse childhood experiences (ACEs) of mothers may negatively affect the mental health of their offspring. Little is known about the intergenerational effect of maternal ACE on post-traumatic stress disorder (PTSD) in the offspring. This study inves-tigated the impact of maternal ACEs on PTSD in the offspring. METHODS: A total of 156 mothers with children aged 13-18 years completed the Diagnostic Interview Schedule for Children (DISC) Predictive Scales to determine the presence of psychiatric disorders in their offspring. The subjects completed the ACE questionnaire and the Early Trauma Inventory Self-Report-Short Form. Multivariable logistic regression was used to analyze the relationship between ma-ternal ACEs and PTSD in the offspring. RESULTS: Of the mothers, 23.7% had at least one ACE, and PTSD was reported in 21.8% of the offspring. The offspring of the mothers in the ACE group had a significantly higher rates of traumatic experiences and PTSD than the offspring of the mothers in the no ACE group. Maternal household dysfunction independently predicted offspring PTSD [odds ratio (OR)=3.008, p=0.05), and three or more maternal ACEs were significantly related to PTSD in the offspring (OR=10.613, p=0.025). CONCLUSION: Maternal ACEs have a significant impact on the risk of traumatic experiences and PTSD in the offspring. These findings suggest the presence of intergenerational transmissions by which maternal ACEs affect the mental health of the offspring.

Re-emerging Neurosyphilis in Korea as a Possible Etiology of Psychotic Disorders with Pleomorphic Symptoms and Cognitive Dysfunction: a Case Report and Literature Review.

Infectious diseases of immigrant populations have recently become important issues for the health of both Korean nationals and foreigners living in Korea. This case report of general paresis is intended to raise awareness about re-emerging neurosyphilis in Korea as a possible etiology of psychotic disorders. A 68-year-old male Chinese resident came to Korea in 2019 with disorientation, auditory hallucination, persecutory delusion, and aggressive behavior, and was admitted to a psychiatric ward for further evaluation and treatment via the emergency department. He was confirmed to have neurosyphilis by serum test, analysis of cerebrospinal fluid, and brain magnetic resonance imaging. After treatment with antibiotics, including intravenous penicillin, in combination with atypical antipsychotics for 6 weeks, his disorientation, auditory hallucination, delusion, and aggressive behavior had attenuated. Neurosyphilis should still be included as a possible etiology of psychotic disorders in Korea. At the initial evaluation, syphilis screening serum tests are recommended for psychotic patients, especially those with pleomorphic symptoms and cognitive dysfunction.

The relationship between diurnal variation of cytokines and symptom expression in mild obstructive sleep apnea.

OBJECTIVES: To identify the relationship between (1) cytokines and everyday symptoms and (2) cytokine diurnal variation and everyday symptoms in mild obstructive sleep apnea (OSA). METHODS: An observational, single-night study of 20 adults with mild to moderate OSA undergoing diagnostic polysomnography. Everyday symptoms included sleepiness measured by Stanford Sleepiness Scale, fatigue and energy levels measured by Lee Fatigue Scale, and cytokine plasma concentrations including interleukin (IL)-1ß, IL-6, IL-8, and tumor necrosis factor-α (TNF-α) measured concurrent with symptoms at presleep (8 pm to 10 pm; time 1) and postsleep (5 am to 6 am; time. 2) Cytokine diurnal variation was calculated as [time 2 - time 1]. Wilcoxon signed-rank tests and Spearman partial rank correlations adjusted for age, body mass index, cardiovascular disease, and type 2 diabetes were used. RESULTS: Twenty patients (50% male, obese, median age = 51.0 years) with mild OSA (apnea-hypopnea index, AHI; median 9.5 events/h) were evaluated. Evening IL-6 was associated with evening symptoms, including sleepiness (r = .69, P = .002) and energy level (r = -0.68, P = .003); morning IL-8 (r = .73, P = .001), and TNF-α (r = .59, P = .015) were associated with morning fatigue. Only morning IL-8 (r = -0.57, P = .022) and diurnal variations in IL-8 (r = -0.60, P = .014) were associated with morning energy level. CONCLUSION: There is scant evidence addressing the diurnal variation of inflammatory biomarkers and the relationship with symptom expression in mild OSA. The present findings provide preliminary mechanistic findings for symptom expression in OSA and contribute insight to mild OSA symptom phenotypes.

Coping Processes, Self-Efficacy, and CPAP Use in Adults With Obstructive Sleep Apnea.

Background: Coping strategies are predictive of 1 week CPAP use. Coping strategies may predict longer-term CPAP use among adults with obstructive sleep apnea (OSA). Objectives: To investigate the influence of two coping styles (active and passive) and individual coping processes on CPAP use at 1 week and 1 month; and explore the association between self-efficacy and coping on CPAP use. Participants: CPAP-naïve adults (52.3% male, 90.9% White) newly diagnosed with OSA (AHI ≥ 5 events/hr) from two U.S. clinical sleep centers (n = 66). Methods: A post-hoc analysis from a prospective, longitudinal study that examined influential factors on CPAP use among CPAP-naïve patients with newly diagnosed OSA. The Ways of Coping Questionnaire and the Self-Efficacy Measure for Sleep Apnea were completed immediately after CPAP titration polysomnography. Objective 1 week and 1 month CPAP use (mean hr/night) were the primary outcomes. Descriptive analyses and stepwise multiple linear regression analyses modeling for CPAP use (mean hr/night). Results: Active coping was significantly associated with greater CPAP use (mean hr/night) at 1 week, but not at 1 month (p = 0.0397; p = 0.0556, respectively). Higher Planful Problem Solving was significantly associated with greater average CPAP use at 1 week and 1 month (p = 0.0117, p = 0.0378, respectively). Self-efficacy was significantly associated with greater average CPAP use at 1 week (p = 0.0056) and 1 month (p = 0.0056). Conclusions: Self-efficacy and Planful Problem Solving coping are promising behavioral intervention targets to promote CPAP use in newly diagnosed OSA.

Association between subclinical hypothyroidism and metabolic syndrome among individuals with depression.

BACKGROUND: Although the connection among low thyroid function, metabolic abnormalities, and depression is well documented, the relationship between subclinical hypothyroidism (SCH) and metabolic syndrome (MetS) in depression remains unclear. This study examined the association between SCH and MetS in a large sample with depression. METHODS: The study analyzed 370 individuals with depression who participated in the 2014 Korea National Health and Nutrition Examination Survey. Associations between the presence of SCH and MetS were estimated after adjusting for related factors using multivariate logistic regression analysis. RESULTS: In the 370 individuals with depression, the prevalence of SCH was 9.4% (SE = 1.6%). The prevalence of MetS was significantly higher in depressed individuals with than in those without SCH (56.3 ±â€¯9.5% vs. 22.8 ±â€¯2.6%; p = 0.001). After adjusting for covariates, the odds of having MetS were 7.127 times greater among depressed individuals with SCH than among those without SCH (95% confidence interval, 2.077-24.458). LIMITATIONS: The cross-sectional study design prevented inferences regarding causality and the effects of changes in variables. CONCLUSIONS: Depressed individuals with SCH are more likely to meet the criteria for MetS. These results highlight the significance of low thyroid function and the metabolic burden of individuals with depression.

Examining Patterns of Polypharmacy in Bipolar Disorder: Findings from the REAP-BD, Korea.

Based on Korean data from the Research on Asian Psychotropic Prescription Pattern for Bipolar Disorder, this study tried to present prescription patterns in biopolar disorder (BD) and its associated clinical features. Based on the information obtained from the study with structured questions, the tendency of prescription pattern was studied and analyzed. Polypharmacy was predominant, including simple polypharmacy in 51.1% and complex polypharmacy in 34.2% of patients. Subjects associated with simple or complex polypharmacy were significantly younger, had higher inpatient settings, a larger portion of onset with manic episode, a shorter duration of untreated illness, a shorter duration of current episode, were more overweight, used less antidepressants and used more anxiolytics. These findings can suggest higher polypharmacy rate in more severe BD and highlight the necessity of monitoring the weight of subjects with polypharmacy.

Clinical Trial Enrollment Enrichment in Resource-Constrained Research Environments: Multivariable Apnea Prediction (MAP) Index in SCIP-PA Trial.

STUDY OBJECTIVES: Determine the Multivariable Apnea Prediction (MAP) index predictive utility for enrollment enrichment in a clinical trial wherein enrollment was prior to obstructive sleep apnea diagnosis. METHODS: Secondary analysis of screening data (n = 264) from randomized, double-blind, pilot trial. Clinical sleep center patients with complete screening and polysomnography data were included. To determine diagnostic test accuracy of the MAP index using apnea-hypopnea index criterion ≥ 10 events/h (primary) and ≥ 5, ≥ 15, and ≥ 30 events/h (secondary), sensitivity, specificity, negative and positive predictive values, likelihood positive and negative ratios, and receiver operating characteristic curves were calculated. Predictive utility was examined by characteristic variables. RESULTS: Middle-aged, overweight or obese, men and women were included. Employing a MAP index threshold ≥ 0.5, sensitivity for obstructive sleep apnea (apnea-hypopnea index ≥ 10 events/h) was 83.6%; specificity was 46.4%; area under the curve = 0.74. Sensitivity was higher in males than females (95.3%, 68.7%, respectively); specificity was lower in males than females (30.4%, 57.6%, respectively) with similar area under the curve (0.74 versus 0.72, respectively). MAP accuracy was higher in younger versus older adults (younger than 50 years, or 50 years or older; area under the curve 0.82 versus 0.63, respectively). Varied apnea-hypopnea index criteria produced stable accuracy estimates. CONCLUSIONS: Recruitment/enrollment is a high-cost endeavor. Screening procedures may confer resource savings but careful evaluation prior to study implementation assures effectiveness and efficiency. CLINICAL TRIAL REGISTRATION: The secondary analysis reports data from the SCIP-PA Trial (NCT 01454830); study information available at: https://clinicaltrials.gov.

Relationship Between Alcohol Consumption and Prostatic Hyperplasia According to Facial Flushing After Drinking in Korean Men.

BACKGROUND: The purpose of this study was to examine whether facial flushing after drinking influences the relationship between alcohol consumption and prostatic hyperplasia among Korean men. METHODS: The subjects were 957 Korean men (180 non-drinkers, 389 with drinking-related facial flushing, 388 without facial flushing) in the 40-69 age group, who underwent prostate ultrasound at the health promotion center of Chungnam National University Hospital between 2008 and 2014. Alcohol consumption and alcohol-related facial flushing were assessed through a questionnaire. In terms of the amount consumed, 14 g of alcohol was considered a standard drink. With the non-drinker group as reference, logistic regression was used to analyze the relationship between weekly alcohol intake and prostatic hyperplasia in the flushing and non-flushing groups, with adjustment for confounding factors such as age, body mass index, smoking, and exercise patterns. RESULTS: Individuals aged 50-59 years who experienced drinking-related facial flushing had a significantly lower risk of prostatic hyperplasia than the non-drinker group, depending on alcohol consumption: ≤4 standard drinks (adjusted odds ratio [OR], 0.38; 95% confidence interval [CI], 0.16 to 0.86); >4 ≤8 standard drinks (OR, 0.35; 95% CI, 0.13 to 0.95); >8 standard drinks (OR, 0.33; 95% CI, 0.13 to 0.84). However, no significant relationship was observed between the number of drinks consumed and the risk of prostate hyperplasia in the non-flushing group. CONCLUSION: The risk of prostatic hyperplasia appears to be reduced by alcohol consumption among Korean men aged 50-59 years who exhibit drinking-related facial flushing.

Characterization of red ginseng residue protein films incorporated with hibiscus extract.

An edible film was prepared from red ginseng residue protein (RGRP) and incorporated with hibiscus extract (HE). RGRP was extracted from red ginseng residue, which is an inexpensive by-product of the red ginseng processing industry. Different concentrations of HE were added to an RGRP film-forming solution as a natural antioxidant. The prepared RGRP films without HE had a tensile strength of 16.9 MPa and an elongation at break of 25.1%. The antioxidant activity of the RGRP film increased with increasing concentration of HE. In addition, the RGRP film with 1% HE exhibited the lowest value of water vapor permeability (1.88×10-9 g·m/m2·s·Pa), which indicates that the film has high water barrier property. The results present the production of edible films from discarded red ginseng residue, and the antioxidant activity of RGRP films as a packaging material can prevent lipid oxidation and quality loss of food products.

Application of a puffer fish skin gelatin film containing Moringa oleifera Lam. leaf extract to the packaging of Gouda cheese.

This study aims to develop a puffer fish skin gelatin (PSG) film that contains Moringa oleifera Lam. leaf extract (ME) as a new biodegradable film. With the increase in ME concentration, the tensile strength and elongation at break of the PSG film increased, whereas the oxygen permeability and water vapor permeability decreased. In addition, the PSG film with ME exhibited antimicrobial activity against Listeria monocytogenes and antioxidant activity. To apply the ME-containing PSG film to food packaging, Gouda cheese was wrapped with the ME-containing PSG film. During storage, the cheese packaging with the ME-containing PSG film effectively inhibited the microbial growth and retarded the lipid oxidation of cheese compared with the control sample. Thus, the ME-containing PSG film can be used as an antimicrobial and antioxidative packaging material to improve the quality of food products.

Application of Lemongrass Oil-Containing Polylactic Acid Films to the Packaging of Pork Sausages.

Polylactic acid (PLA) is a biodegradable and renewable polymer, which represents a valuable alternative to plastic packaging films, often associated with environmental problems. In this study, we tested the suitability of PLA as a biodegradable packaging film and assessed the antimicrobial activity of lemongrass oil (LO), incorporated into the PLA film in different concentrations. To obtain the optimal physical properties for PLA films, tensile strength, elongation at break, and water vapor permeability were measured under different preparation conditions. In addition, the antimicrobial activity of the LO contained in the PLA film against Listeria monocytogenes was investigated by disc diffusion and viable cell count. Among all concentrations tested, 2% LO was the most suitable in terms of antimicrobial activity and physical properties of the PLA film. Based on these results, we used the PLA film containing 2% LO to pack pork sausages; after 12 d of storage at 4℃, the population of inoculated L. monocytogenes in the sausage samples wrapped with the PLA film containing 2% LO was reduced by 1.47 Log CFU/g compared with the control samples. Our data indicate that PLA films containing 2% LO represent a valuable means for antimicrobial sausage packaging.