Mediating and Moderating Effects of Uncertainty on the Relationship between Family Function, Self-Care, and Depression among Blood Cancer Survivors.

Uncertainty in cancer survivorship poses a substantial challenge to survivors' coping mechanisms and psychological well-being. This study investigated the intricate interplay among family function, uncertainty, self-care, and depression in this context, with a primary focus on discerning the mediating and moderating roles of uncertainty in the relationship between family function, self-care, and depression among blood cancer survivors. Cross-sectional data from 147 survivors in South Korea underwent analysis using descriptive statistics, Pearson's correlations, and the PROCESS macro in SPSS version 26.0. The results revealed that family function significantly predicted both self-care and depression. Notably, uncertainty mediated the relationship between family function and these outcomes. Furthermore, the impact of family function on depression was moderated by uncertainty, indicating a relatively weaker association in survivors facing higher uncertainty levels. This study contributes valuable insights by elucidating the role of uncertainty in regulating how family function influences self-care and depression among survivors of blood cancer. It emphasizes the critical need to enhance family function and alleviate uncertainty for the improved adjustment of cancer survivorship. The findings underscore the importance of targeted support for individuals grappling with different levels of uncertainty, aiming to prevent or mitigate depressive symptoms through the reinforcement of family function.

Korean Nursing Students' Experiences of Virtual Simulation Programs Replacing In-Person Mental Health Nursing Practicum during the COVID-19 Pandemic.

This qualitative study explored the experiences of nursing students whose clinical practice in mental health nursing had been substituted with virtual simulation programs due to the COVID-19 pandemic. The participants were ten nursing students who had undergone a virtual simulation program-centered practice, replacing the traditional clinical practice in mental health nursing and previous clinical practice in mental health nursing. The data were collected through in-depth individual interviews from January to February 2021. Following Braun and Clarke's method, the thematic analysis identified five themes and ten sub-themes. The five themes included the following: (1) lack of vibrancy in the actual clinical setting, (2) limited direct and indirect practical experience, (3) performing diverse roles in a virtual setting, (4) learner-directed practicum, and (5) sense of relief due to a safe virtual practicum environment. The participants recognized the limitations of the practice, particularly regarding communication with patients with mental disorders in the virtual simulation program. However, their perception of nursing underwent a positive change through the indirect clinical practice experience. Accordingly, it is necessary to develop a platform for the mental health nursing practicum that can easily interact with clients and to establish a hybrid practice that combines the clinical practice and virtual simulation practice.

Validation of the Korean Version of the Health Care Climate Questionnaire among Cancer Survivors.

Healthcare professionals should support autonomy in their patients in order for them to maintain the motivation to cope actively with their conditions. The Health Care Climate Questionnaire (HCCQ) is useful for assessing patients' perceptions of the autonomy support provided to them. We aimed to validate the psychometric properties of the Korean version of the HCCQ (HCCQ-K) among Korean cancer survivors. This study evaluated the factor structure, concurrent validity, and internal consistency. Data from 367 cancer survivors were analyzed using confirmatory factor analysis (CFA), Pearson's correlations, and Cronbach's α values. The CFA validated that the single-factor structure of the HCCQ-K had an excellent fit that was consistent with that of the original English version. Concurrent validity was confirmed by moderate correlations between the HCCQ-K and both psychological well-being and self-management. Reliability was verified by satisfactory internal consistency, with a Cronbach's α value of 0.91 and strong item-total and inter-item correlations. The HCCQ-K is therefore a valid and reliable tool for assessing autonomy support provided by healthcare professionals to Korean cancer survivors. The HCCQ-K may help healthcare professionals understand their patients' needs for autonomy support and develop strategies to motivate active coping behaviors.

Examining the heterogeneity by employment status in dynamics between BMI and cognition: a longitudinal cohort study of the Korean aging population.

PURPOSE: This study investigated the potential heterogeneity by employment status in the relationship between body mass index (BMI) trajectory and cognitive function among an aging population. METHODS: We analyzed 2010-2018 cohort data from the Korean Longitudinal Study of Aging involving 4889 individuals aged over 45. We used statistical techniques of quadratic terms, interaction terms, time-invariant unobserved fixed effects, and time-lag effects to estimate the dynamic and interactive relationships among study variables. RESULTS: The effect of BMI on cognitive function was heterogeneous based on employment status. For the nonemployed group, the impact of BMI on cognitive function showed an inverted U-shape with a turning point (BMI 25); a higher BMI (up to 25) was associated with higher cognitive function, but further increases beyond this threshold led to decreased cognitive function. For the employed group, however, the impact of BMI on cognitive function was nonsignificant. The nonlinear effect of BMI on cognitive function for the nonemployed group was robust across various subgroups and specifications. CONCLUSIONS: The findings highlight the risk of obesity (BMI ≥ 25) on cognitive decline, particularly among nonemployed individuals. This illuminates the critical role of labor activity in regulating the impact of BMI on cognitive function among an aging population.

Threshold effects of body mass index on cognitive function and heterogeneity by sex and cardiovascular risk factors.

Background: Disclosing the underlying relationship between body mass index (BMI) and cognitive decline is imperative for cognitive impairment prevention and early detection. Empirical studies have indicated the risk of abnormal BMI leading to cognitive impairment. However, the relative risk of underweight or overweight on cognitive function is obscure. This study investigated the asymmetric causal effect of BMI on cognitive decline below and above an unknown threshold and the heterogeneity in the threshold level and the magnitude of the threshold effect due to sex and cardiovascular risk factors. Methods: This study used 2010-2018 panel data from the Korean Longitudinal Study of Aging that assessed sociodemographic and health-related trends in Korean middle-aged to older population. A generalized method of moments estimator of the panel threshold model was applied to estimate the potential nonlinear pattern between BMI and cognitive function. Results: There was a threshold effect in the relationship between BMI and cognitive function. An increase in BMI below the threshold was associated with higher cognitive function, whereas a further increase in BMI above the threshold led to cognitive decline. The nonlinear pattern between BMI and cognitive function differed by sex and cardiovascular risk appearing more distinctively within men or the cardiovascular risk group. Conclusions: The detrimental impact of being underweight or overweight on cognitive function is heterogeneous by sex or cardiovascular risk. For obese men or individuals with cardiovascular risk factors, maintaining adequate BMI should be highlighted to help prevent cognitive decline.

Validation and psychometric properties of the multidimensional scale of perceived social support among Korean breast cancer survivors.

Objective: Social support plays a key role in dealing with various challenges accompanying cancer treatment and survivorship. The multidimensional scale of perceived social support (MSPSS) is a valid measurement used globally to assess general support from social interpersonal relations. This study aims to validate the psychometric properties of the Korean version of the MSPSS among Korean women with breast cancer. Methods: Two independent cross-sectional studies collected data from 349 non-metastatic breast cancer survivors. Statistical analyses of confirmatory factor analyses, t-test, and Pearson correlation were performed to test construct validity, including factorial structure, concurrent validity, and known-group comparisons. Internal consistency and test-retest reliability were used to evaluate the reliability. Results: Factor analysis confirmed a three-factor construct (i.e., family, friends, and spouse) with good fit indices. Concurrent validity was verified by correlations with social well-being and interpersonal relationships, which are theoretically relevant concepts. Known-group validity was also confirmed by different MSPSS scores according to depression and symptom distress levels. Reliability was supported by good internal consistency and acceptable test-retest correlation coefficients. Conclusions: The findings demonstrate the MSPSS is a valid and reliable measurement to assess the extent to which women with breast cancer perceive social support from spouses, other family members, and friends in Korea. Further studies should verify the psychometric properties of the MSPSS in patients with other cancers beyond breast cancer. Health professionals could administer the MSPSS to evaluate the diverse resources of social support among cancer survivors.

Age and sex-specific associations between depressive symptoms, body mass index and cognitive functioning among Korean middle-aged and older adults: a cross-sectional analysis.

BACKGROUND: Although depression and body weight have been noted as important predictors of cognitive health, it remains unclear how age and sex influence the mechanism by which depressive symptoms and body weight are associated with cognitive functioning. This study examined whether and how the relationships between depressive symptoms and cognitive functioning mediated by body mass index (BMI) differ in terms of age and sex. METHODS: A cross-sectional analysis of a large sample of population-based data (N = 5,619; mean age 70.73 [± 9.07]), derived from the Korean Longitudinal Study of Aging, was conducted with hierarchical mediated-moderation regressions and a PROCESS macro approach in SPSS. Depressive symptoms were measured through the 10-item Center for Epidemiologic Studies Depression (CES-D) scale, and cognitive functioning was assessed with the Korean Mini-Mental State Examination (K-MMSE). RESULTS: The results showed that depressive symptoms were significantly associated with cognitive decline directly and indirectly through reduced BMI. The estimated coefficients indicated that a one standard deviation increase in CES-D scale was associated with about 0.9 decrease in K-MMSE score. However, the indirect relationship between depressive symptoms and cognitive function through BMI emerged only in men or individuals older than 70 years. CONCLUSIONS: The findings suggest that a careful assessment of BMI is warranted for early detection and prevention of cognitive decline related to depressive symptoms, particularly among older men.

Impact of Autonomy Support on the Association between Personal Control, Healthy Behaviors, and Psychological Well-Being among Patients with Hypertension and Cardiovascular Comorbidities.

A sense of control and autonomy are key components in guiding health-related behaviors and quality of life in people with chronic diseases. This study investigated whether autonomy support from health professionals moderates the impact of personal control on psychological well-being through healthy behaviors in patients with hypertension and cardiovascular comorbidities. Data from 149 hypertensive patients with comorbid cardiovascular risk factors were collected via self-administered surveys. A moderated mediation effect of a hypothesized model was analyzed using the PROCESS macro bootstrapping method. Autonomy support from health professionals moderated the relationship between personal control and healthy behaviors (B = 0.16, t = 2.48, p < 0.05), showing that the effect of personal control on healthy behaviors differed by the level of autonomy support. Additionally, autonomy support moderated the mediation effect of healthy behaviors in the relationship between personal control and psychological well-being (Index = 0.15; 95% CI = 0.010, 0.335). The mediation effect existed only in patients with higher autonomy support. The findings demonstrate that autonomy support from health professionals plays a crucial role in reinforcing the positive impact of personal control on healthy behaviors and psychological well-being. Enhancing the supportive attitudes of health professionals that facilitate patients' autonomous self-regulation is necessary for better health outcomes in people with combined cardiovascular diseases.

Factors Affecting Psychological Burnout in Nurses Caring for Terminal Cancer Patients.

Purpose: This study aimed to investigate the impacts of end-of-life care competency and ethical dilemmas on psychological burnout in nurses who care for terminal cancer patients. Methods: A cross-sectional study of 160 nurses who cared for terminal cancer patients was conducted. The participants were recruited from the hospice-palliative care wards, hematology or oncology wards, or intensive care units of three general hospitals in a single metropolitan area. Data were collected using a self-administered survey to assess end-of-life care competency, ethical dilemmas, psychological burnout, and general sociodemographic characteristics. Data were analyzed using descriptive statistics, the independent t-test, analysis of variance, Pearson correlation coefficients, and hierarchical linear regression analysis using SPSS for Windows (version 26.0). Results: Psychological burnout was significantly correlated with end-of-life care competency (r=-0.23, P=0.003) but not with ethical dilemmas. The results of the hierarchical linear regression analysis indicated that end-of-life care competency (ß=-0.280, P=0.010) and ethical dilemmas (ß=0.275, P=0.037) were significant predictors of psychological burnout, after adjusting for age, religious status, clinical experience, and unit type. Conclusion: The current study's findings demonstrate that end-of-life care competency and ethical dilemmas are crucial factors that affect psychological burnout in nurses who care for terminal cancer patients. Substantive education programs must be developed to improve nurses' competencies in end-of-life care and ethical dilemmas to decrease psychological burnout.

Influence of Spirituality and Job Satisfaction on the Compassion Competence of Hospice Nurses.

Purpose: The aim of this study was to examine the influence of spirituality and job satisfaction on the compassion competence of hospice nurses. Methods: This was a cross-sectional study of 118 hospice nurses from 16 hospitals in Daejeon, Chungcheong Province, and Jeolla Province. A self-administered survey was conducted using a structured questionnaire including the Spirituality Scale, Index of Work Satisfaction, the Compassion Competence Scale for Nurses, and general socio-demographic information. The data were analyzed using descriptive statistics, the t-test, Pearson correlation coefficients, and hierarchical linear regression analysis using SPSS for Windows version 26.0. Results: Compassion competence was correlated with spirituality (r=0.66, P<0.001) and job satisfaction (r=0.52, P<0.001), and spirituality was correlated with job satisfaction (r=0.44, P<0.001). Spirituality (ß=0.513, P<0.001) and job satisfaction (ß=0.273, P<0.001) were significant factors affecting the compassion competence of hospice nurses, after adjusting for the sociodemographic and work-related covariates. The step-by-step results from hierarchical linear regression analysis also indicated that spirituality had a stronger impact than job satisfaction on compassion competence. Conclusion: Our findings demonstrate the importance of spirituality, which plays a role in guiding the compassion competence of hospice nurses. It is necessary to support the spirituality and job satisfaction of hospice nurses, which could facilitate their compassion competence and thereby contribute to improving the quality of hospice and palliative care.

The association of education level with autonomy support, self-efficacy and health behaviour in patients with cardiovascular risk factors.

AIM AND OBJECTIVES: The study aimed to investigate whether the patients' education level affected the mediation effect of self-efficacy on the relationship between the autonomy-supportive healthcare climate and health behaviour among patients with cardiovascular risk factors. BACKGROUND: Autonomy and self-efficacy are identified as influential factors related to the behaviours of individuals with health problems. However, it is unclear whether autonomy support from healthcare providers affects health behaviour through self-efficacy and if patients' education level affects the association. DESIGN: A cross-sectional study. METHODS: A convenience sample of 207 individuals with one or more cardiovascular diseases completed self-administered surveys including the healthcare climate questionnaire, self-efficacy scale and the engagement in health behaviour scale. Data were analysed using descriptive statistics, t test, Pearson's correlation coefficients and hierarchical regression analysis. All procedures of the study adhered to the STROBE guidelines. RESULTS: The influence of autonomy support from healthcare providers on self-efficacy differed by individuals' education level. Self-efficacy in less educated, but not highly educated individuals, tended to depend on the autonomy-supportive climate. Additionally, the autonomy-supportive healthcare climate affected health behaviour through self-efficacy only in less educated individuals. CONCLUSION: The relationship between autonomy support from healthcare providers and self-efficacy was more evident in the relatively less educated individuals. The associations among autonomy support, self-efficacy and health behaviour differed by patient education level, and the mediating role of self-efficacy on the relationship between autonomy-supportive climate and health behaviour was found only in those less educated. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers should recognise the importance of supporting patients' need for autonomy to improve self-efficacy and healthy behaviour, particularly in less educated patients. Additionally, healthcare providers' support tailored to patients' needs and educational status should be highlighted.

The Effects of the Nursing Practice Environment and Self-leadership on Person-centered Care Provided by Oncology Nurses.

Purpose: This study aimed to investigate the effects of the nursing practice environment and self-leadership on person-centered care provided by oncology nurses. Methods: This cross-sectional study included 145 nurses who worked in oncology wards at eight university hospitals in Seoul, Daejeon, and Chungcheong Province with at least six months of experience. Data were collected using a self-administered survey and analyzed using descriptive statistics, Pearson correlation coefficients, the t-test, analysis of variance, and hierarchical multiple regression analysis in SPSS version 26.0. Results: Person-centered care was significantly correlated with the nursing practice environment (r=0.27, P<0.001) and self-leadership (r=0.40, P<0.001), and the nursing practice environment was correlated with self-leadership (r=0.380, P<0.001). Hierarchical multiple regression analysis showed that the nursing practice environment was a significant predictor of person-centered care (ß=0.31, P<0.001), after adjusting for covariates including monthly salary, total clinical career, and the position of oncology nurses. Self-leadership was a significant predictor of person-centered care (ß=0.34, P<0.001) after controlling for the nursing practice environment, along with covariates. The final model explained 18.7% of the variance in person-centered care. Conclusion: Our findings emphasize the importance of the nursing practice environment and nurses' self-leadership for providing person-centered care in oncology care units. Educational programs to reinforce nurses' self-leadership and administrative support for nursing practice are necessary to improve oncology nurses' capability to provide person-centered care.

The Effects of Counseling about Death and Dying on Perceptions, Preparedness, and Anxiety Regarding Death among Family Caregivers Caring for Hospice Patients: A Pilot Study.

Purpose: This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients. Methods: Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospice and palliative care unit. Perceptions, preparedness, and anxiety regarding death were assessed with a self-administered structured questionnaire, and participants' scores before and after counseling were compared using the paired t-test. Results: Significant changes were found in perceptions, preparedness, and anxiety regarding death after counseling. Compared to before counseling, the scores for perceptions of death (t=-4.90, P<0.001) and preparedness for death and dying (t=-16.23, P<0.001) improved, while anxiety (t=3.72, P=0.001) decreased after counseling. Some changes were also found in the types of support that family caregivers needed to prepare for the death of their family members in the hospice care unit. Conclusion: The findings demonstrate that death counseling could help family caregivers prepare for the death of their loved ones. Hospice and palliative care providers should play a key role in supporting family caregivers of hospice patients by developing strategies for counseling.

Sex Differences in the Influence of Sleep on Body Mass Index and Risk of Metabolic Syndrome in Middle-Aged Adults.

Poor sleep and obesity are intimately related to cardiovascular diseases. We aimed to examine whether the influence of sleep and body mass index (BMI) on the risk of metabolic syndrome (MetS) differed by sex in middle-aged people. It is a cross-sectional study of 458 Korean participants who completed self-administered surveys; the data were analyzed using the PROCESS macro for SPSS. We found that both sleep and BMI were significant predictors of MetS risk in women, particularly by the role of BMI connecting the impact of sleep to MetS risk. However, the association was not found in men, showing that BMI, but not sleep, was a significant predictor of MetS. This sex-related difference was due to different relationships between sleep and BMI, indicating that BMI was more dependent on sleep quality for women than for men. Therefore, a sex-specific approach to decrease the risk of MetS is warranted.

Interactive Impact of Sleep Duration and Sleep Quality on the Risk of Developing Metabolic Syndrome in Korean Adults.

Sleep quality is important for the normal functioning of hormonal and metabolic processes in the body; however, few studies have considered the effects of both sleep duration and sleep quality on predicting metabolic syndrome risk. We examined the interactive impact of sleep duration and sleep quality on the risk of developing metabolic syndrome using logistic regression analysis with a threshold based on hours of sleep. Data were collected from 411 adults in South Korea and, according to the estimated threshold of 6 h of sleep (95% Confidence Interval, CI = 5-7 h), participants were classified as short (<6 h) or adequate-long (≥6 h) sleepers. The two groups differed significantly on various health measures. While short sleepers were more likely than adequate-long sleepers to experience adverse health conditions, which increased their risk of developing metabolic syndrome, they were not influenced by sleep quality. For adequate-long sleepers, however, a decrease in sleep quality was associated with an increased risk of developing metabolic syndrome (odds ratio = 1.24, 95% CI = 1.07-1.43). Our results suggest that both sleep duration and sleep quality are crucial determinants of the development of metabolic syndrome and that it is important to maintain at least 6 h of sleep.

Estimating a breakpoint in the pattern of spread of COVID-19 in South Korea.

OBJECTIVES: Amid the global coronavirus disease 2019 (COVID-19) crisis, South Korea has been lauded for successfully preventing the spread of this infectious disease, which may be due to the aggressive implementation of preventive policies. This study was performed to evaluate the pattern of spread of COVID-19 in South Korea considering the potential impact of policy interventions on transmission rates. METHODS: A SIR (susceptible-infected-removed) model with a breakpoint that allows a change in transmission rate at an unknown point was established. Estimated trajectories of COVID-19 from SIR models with and without a breakpoint were compared. RESULTS: The proposed model with a break fitted the actual series of infection cases much better than the classic model. The estimated breakpoint was March 7, 2020 and the transmission rate dropped by 0.23 after the breakpoint. A counterfactual study based on our estimate indicated that the number of infected could have reached 2 500 000 compared to the peak of 8000 in the observed series. CONCLUSIONS: It is critical to consider a change in the transmission rate to evaluate the trajectory of spread of COVID-19 in South Korea. Our estimation and counterfactual experiments indicate that public health interventions may play a role in determining the pattern of spread of infectious diseases.

Gender Difference in the Relationship Among Family Function, Health Behavior, and Stress in Midlife.

This study investigated whether there are gender-based differences in the process wherein family functions influence stress through various health behaviors in midlife adults. A cross-sectional study was done using a convenience sample of 250 middle-aged Koreans. Data on the family APGAR index, four health behaviors (i.e., seeking health information, physical activity, healthy diet, and social interaction), and stress were collected by a self-administered survey and analyzed using hierarchical multiple linear regression analyses and a PROCESS macro for SPSS. The study results showed that an indirect effect of family function on stress through health behaviors was significant in women, whereas such a relationship was not shown in men. This study found that the process wherein family function is linked with stress through health behaviors differs by gender. Developing gender-specific interventions is essential to decrease stress in midlife adults.

Gender differences in climacteric symptoms and associated factors in Korean men and women.

Both men and women may experience multifaceted symptoms that are part of natural aging throughout the climacteric period. This study compared the prevalence and severity of climacteric symptoms between genders and identified the underlying clusters of climacteric symptoms and associated factors in midlife men and women. A cross-sectional study was done with 254 middle-aged Korean men (n = 129, M = 50.4) and women (n = 125, M = 49.5). Data were collected by self-administered surveys and analyzed using t-tests, chi-square tests, exploratory factor analysis, and regression analysis. Significant gender differences in overall climacteric symptoms were not detected except for muscle weakness, weight gain, and hot flashes. Climacteric symptoms were clustered as physical, vasomotor-genital, psychological, and metabolic dimensions, with the physical dimension being the most explanatory cluster. A significant gender effect was found only in the metabolic dimension after adjusting for the relevant covariates, and regular eating was significantly associated with all symptom clusters. This study offers evidence that most climacteric symptoms are shared by both men and women and emphasizes the importance of healthier lifestyles in the climacteric transition period. The findings highlight the critical need for integrated assessments of the multifactorial symptoms and of modifying poor lifestyles in both genders throughout the climacteric transition period.

Influence of home care services on caregivers' burden and satisfaction.

AIMS AND OBJECTIVES: To examine the factors affecting the burden and satisfaction of family caregivers, focusing on the beneficial impacts of home care service use. BACKGROUND: Long-term care for older patients is a multifaceted process that brings both burden and satisfaction to family caregivers. It is expected that home care services offered by the Korean long-term care insurance may contribute to decreasing the burden of family caregivers and enhancing their satisfaction by assisting with practical caregiving tasks. DESIGN: A cross-sectional study. METHODS: A convenience sample of 157 family caregivers was recruited from five home care service agencies in South Korea. Information about the caregivers, caregiving history, older care recipients and use of home care services was assessed. The effects of home care service use on caregiving burden and satisfaction were tested using hierarchical multiple regression analyses after adjusting for the characteristics of the caregivers, caregiving history and older care recipients. RESULTS: There was no significant influence of home care service use on reducing caregiving burden or on increasing caregivers' satisfaction. Although several factors were associated with caregiving burden and satisfaction, family functioning was the most unique factor to significantly affect both caregiving burden and satisfaction. CONCLUSIONS: Home care services might not automatically have a positive impact on caregivers' burden and satisfaction, but maintaining healthy family functioning is an important issue for family caregivers. The findings highlight the important need to reconsider ways to provide home care services and to develop nursing interventions to reinforce supportive family functioning. RELEVANCE TO CLINICAL PRACTICE: Practical strategies for providing home care services should be developed through a concrete assessment of the family dynamics and the needs of family caregivers. Health professionals should play a pivotal role in performing the assessment and in developing interventions to strengthen supportive family functioning.