Internet-Based Trauma Recovery Intervention for Nurses: A Randomized Controlled Trial.

Introduction: Nurses, who care for patients with various traumas, may also experience post-traumatic stress disorder due to indirect or direct exposure to traumatic situations. This study examined the effectiveness of an Internet-based trauma recovery intervention for Korean nurses. Methods: This randomized controlled trial was conducted with 112 nurses aged 23-40 years who were randomly assigned to the intervention (n = 56) or control group (n = 56) from May 7 to December 20, 2020. Nurses in the intervention group attended eight sessions, and the same intervention was administered to the control group. Repeated measures were collected at pre-test, post-test 1 (immediately after the intervention), and post-test 2 (4 weeks after the intervention). A total of 102 nurses (intervention group: n = 49; control group: n = 53) were completed because 10 nurses dropped out before the first session. Data were analyzed using the χ2 test, Fisher's exact test, t-test, Mann-Whitney U test, and repeated measures ANOVA (intention-to-treat and per protocol). Results: There were significant changes in functional health, resilience, post-traumatic stress, depressive symptoms, state anxiety, and trait anxiety over time and in the group-by-time interactions (intention-to-treat and per protocol). There was a significant difference in social support in the group-by-time interactions, but there were no significant changes between the two groups or over time (intention-to-treat and per protocol). Conclusion: The Internet-based trauma recovery nursing intervention is effective in clinical and community settings for nurses who cannot participate in fixed-schedule programs due to shift work. This study's findings are relevant for implementing Internet-based trauma recovery programs for nurses and the general population, including survivors and relatives of patients who suffered from COVID-19. This program will also be very useful for people in other high-stress situations. Nurse leaders should consider different populations and situations when offering effective coping strategies suitable for changing environments.

Factors that influence hospitalization stress in patients with chronic schizophrenia: A cross-sectional study in psychiatric hospitals.

WHAT IS KNOWN ON THE SUBJECT?: Patients with chronic schizophrenia become vulnerable to stress when admitted to psychiatric wards, lacking the abilities to independently cope with stress. Therefore, it is crucial to focus on the stress associated with hospitalization. Stress increases when interpersonal functioning is impaired due to schizophrenia symptoms. Social support acts as a protective factor against stress, boosting coping skills and problem-solving abilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Interpersonal relationships, marital status, having cohabited before hospitalization and hospitalization type were associated with hospitalization stress in patients with chronic schizophrenia. Patients with chronic schizophrenia continue aging (mean 55.73 ± 11.14) within closed psychiatric hospitals due to their long-term hospitalizations (mean 14.24 ± 11.37). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need to use a standardized nursing assessment including interpersonal relationships, family support system and hospitalization type that may affect hospitalization stress in patients with chronic schizophrenia. Mental health nurses should develop tailored interventions to reduce hospitalization stress for long-stay patients with chronic schizophrenia that consider aging, illness duration, and length of hospital stay, as well as psychiatric symptoms. Mental health nurses need to make efforts to help the families of patients with schizophrenia solidify an important support system by participating in treatment plans and intervention programs, checking on the patients' condition, and spending time with them. ABSTRACT: INTRODUCTION: Patients with chronic schizophrenia in psychiatric hospitals often experience increased stress due to living in closed spaces and frequently lack the coping skills necessary for independent stress management. AIM: To explore interpersonal relationships, social support and hospitalization stress, and identify the factors associated with hospitalization stress in patients with chronic schizophrenia in psychiatric hospitals. METHOD: This cross-sectional study included 135 patients who had been diagnosed with schizophrenia for over 2 years, recruited from two psychiatric hospitals in City B, South Korea through convenience sampling. We conducted descriptive statistics and quantile regression. RESULTS: Interpersonal relationships, marital status, cohabiting before hospitalization, and voluntary admission were significant factors influencing the hospitalization stress at the 90th percentile. DISCUSSION: Standardized nursing assessment, active family support, and tailored stress management programs including interpersonal relationships are needed to reduce hospitalization stress in patients with chronic schizophrenia. IMPLICATIONS FOR PRACTICE: To identify the 90th percentile group for hospitalization stress among patients with chronic schizophrenia, it is essential to consider interpersonal relationships, marital status, pre-hospitalization cohabitation, type of hospitalization, as well as aging and prolonged hospitalization. Mental health nurses should develop and implement family therapy-based interpersonal relationship programs to reduce hospitalization stress in patients with chronic schizophrenia and actively involve families in the process.

A Caring Program for Health Promotion among Women Who Have Experienced Trauma: A Quasi-Experimental Pilot Study.

PURPOSE: Women are more vulnerable to post-traumatic stress (PTS) than men, causing several health problems. Nurses should understand and work with women who have experienced trauma and provide interventions to promote their physical, social, and mental health. METHODS: This quasi-experimental pilot study used a one-group pre-test/post-test design. Data were collected from 14 women recruited between December 2019 and May 2020 from a self-sufficiency support center in South Korea for sexually-exploited women who had experienced trauma. The program consisted of six one-on-one intervention sessions per week for six weeks. Each session averaged 60~120 minutes. Participants were assessed at pre-test, post-test, and one-month follow-up. Changes in outcome variables over time were analyzed using the Wilcoxon signed-rank and Friedman tests. RESULTS: The caring program for health promotion was divided into six sessions: understanding the self, sharing traumatic events and negative emotions, reframing the meaning of traumatic events, identifying thoughts and physical and emotional responses, developing health promotion activities, and maintaining a positive attitude during the process of change. As a result of the caring program, PTS (F = 36.33, p < .001), depression (F = 24.45, p < .001), health-promoting behaviors (F = 7.06, p =.004), and self-esteem (F = 19.74, p < .001) among the participants differed significantly at pre-test, post-test, and follow-up. CONCLUSION: This study provides foundational information for the implementation of a theory-driven program by nurses in clinical and community settings to provide comprehensive care for women who have experienced trauma.

Impact of vertical stratification on the 2020 spring bloom in the Yellow Sea.

The Yellow Sea is one of the world's most abundant marine resources, providing food and economic benefits to the Korean and Chinese populations. In spring 2020, a decrease in the intensity of phytoplankton bloom was observed. While one study attributed this decline to a decrease in nutrient associated with the COVID-19 pandemic, our previous research proposed weakened thermal stratification accompanied by a surface cooling anomaly as the cause. However, the relationship between the marine environment and ecosystem has not been fully elucidated. Using observations and marine physical-biogeochemical model data, we identified the weakened stratification as a critical factor for suppressing the 2020 spring bloom. Intense vertical mixing hindered the accumulation of nutrient and chlorophyll-a concentrations within the euphotic zone, resulting in a diminished phytoplankton bloom. In contrast, reduced nitrate and phosphate concentrations in 2020 were insignificant compared to those in 2017-2019, despite the notable decline in PM2.5 in March 2020 due to COVID-19. In April 2020, nutrient levels fell within the range of interannual variability based on long-term observations, reflecting a negligible effect on the spring phytoplankton bloom. Our findings provide insight into the importance of marine physical factors on the phytoplankton biomass in the Yellow Sea.

Evaluation of Internet-Based Training in Trauma Care for Nurses in Mental Health Welfare Centers: A Cluster Randomized Controlled Trial.

OBJECTIVE: This study evaluates the efficacy of Internet-Based Training in Trauma Care for Nurses (IBTTCN) to improve nurses' trauma intervention self-efficacy, professional quality of life, and attitudes and knowledge about post-traumatic stress disorder. METHODS: Forty-one nurses participated from May to July 2021. The assessment points were at baseline (T1), immediately after program completion (4 weeks; T2), and 1 month after T2 (T3). Data were analyzed using repeated-measures analysis and generalized estimating equations. RESULTS: In the intervention group, trauma intervention self-efficacy increased significantly after the IBTTCN, and the effect of such self-efficacy over time was significant. CONCLUSIONS: The IBTTCN improved nurses' trauma intervention self-efficacy.

Causes for an extreme cold condition over Northeast Asia during April 2020.

Although 2020 was the fourth warmest year on record in northern Asia, the cold condition in April 2020 caused severe damage to the agricultural and marine ecosystems in northeastern Asia. Previous studies have indicated that the dipole atmospheric circulation over Siberia and the East Sea (Japan Sea) produced this cold environment with strong northwesterly wind. However, the potential causes of the dipole circulation over northeastern Asia remain unclear. In this study, we found that the East Atlantic/Western Russia (EAWR) pattern and blocking combined to produce the atmospheric structure. The wave train originated from the vorticity forcing of northwestern/central Russia and propagated from Western Europe to the East Sea via the background westerly and northerly winds. In addition, the Siberian blocking days increased eleven times in April 2020 relative to the climatological average, and an easterly (westerly) anomaly was observed over Mongolia-northeastern China (northern Russia). The strong blocking and EAWR pattern led to the robust atmospheric dipole structure with a prevailing northerly flow in April 2020, thereby causing the extreme cold condition over northeastern Asia. Our results provide novel insights into the cause of extreme cold condition in April over northeastern Asia.

Decreasing patterns of depression in living alone across middle-aged and older men and women using a longitudinal mixed-effects model.

There is little evidence regarding the association between living arrangement and depression, and no studies have examined the age- and gender-specific differences in this association. The present study sought to examine the longitudinal changes in depression patterns between isolative living versus living in company among middle-aged and older men and women by obtaining data from waves 1-7 of the Korean Longitudinal Study of Aging (KloSA), which comprises a sample of persons at least 45 years of age in the Republic of Korea (2273 middle-aged and 1387 older men, 2805 middle aged and 1862 older women). Depression scores were based on the self-reported Center for Epidemiologic Studies Depression Scale (CES-D-10) short forms. Using mixed-effect linear regression models, we estimated depression patterns by living arrangement across age- and gender groups. Our findings from the mixed-effects model revealed that over a 14-year follow-up period, there were significant decreasing patterns of depression were among middle-aged men and women, and older men living alone compared to living with a spouse and living with others. However, living alone still had the highest depression compared to other living arrangement types. On the other hand, the depression of older women living alone changed to a level similar to those living with others during the follow-up period. In conclusion, these findings indicate that living alone significantly increases the risk of depression, but the risk decreases over time. Additionally, depression patterns by living arrangement proved to differ across age and gender groups.

Association between post-traumatic stress symptoms and functional health among internally displaced people in Myanmar.

WHAT IS KNOWN ON THE SUBJECT?: Internally displaced persons (IDPs) in Myanmar have been exposed to conflict and violence for a long time and experience physical, psychological and social problems. Post-traumatic stress symptoms (PTSS) are more prevalent among IDPs than among general populations and refugees, and limited research is available on this topic among IDPs in Myanmar. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: More than one-third of the IDPs in our sample from Myanmar camps had a high PTSS score. More than two-thirds experienced traumatic events and left home after age 18. The overall functional health of IDPs was poor, and the presence or absence of PTSS led to differences in the factors associated with functional health in each group. Resilience and PTSS were associated with the functional health of IDPs in Myanmar. Further, functional health was positively correlated with levels of resilience among those relatively low in PTSS. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need to assess IDPs' health status and PTSS by first performing health screening at camps in Myanmar. Subsequently, tailored interventions can be provided according to individual health conditions and PTSS severity. IDPs in Myanmar need psychological first aid to cope with the ongoing conflict and violence, and further mental health nurse training is necessary to implement this aid and tailored interventions for PTSS. ABSTRACT: INTRODUCTION: Internally displaced persons (IDPs) are individuals forced to leave their homes and move within their country. Post-traumatic stress symptoms (PTSS) are prevalent in this population. AIM: To investigate trauma symptoms and functional health of IDPs in Myanmar and identify the factors associated with their functional health according to the presence/absence of PTSS. METHOD: This cross-sectional study included 201 IDPs who completed a questionnaire on functional health, PTSS, resilience, social support and hope. The analysis included descriptive statistics, t-tests, Pearson's correlation coefficients and multiple linear regression with interaction analyses. RESULTS: Over one-third of the participants had PTSS, with low functional health scores. The greater the resilience, the better the functional health. The higher participants' PTSS, the poorer their functional health. There was a significant interaction between resilience and PTSS. DISCUSSION: Tailored resilience-building programs, as well as health policies and services, are needed to enhance IDPs' functional health and help them overcome PTSS. IMPLICATIONS FOR PRACTICE: Psychological first aid should be provided to minimize PTSS experienced in situations of ongoing conflict and violence. Mental health nurses should be trained to assess IDPs' health status and tailor interventions accordingly.

Combined effects of handgrip strength and sensory impairment on the prevalence of cognitive impairment among older adults in Korea.

Older adults commonly experience concurrent lower handgrip strength and sensory impairment. However, previous studies have analyzed the individual effects of either handgrip strength or sensory impairment on cognitive impairment. To address this gap, this study investigated the combined effects of handgrip strength and sensory impairment on cognitive impairment among older adults. In total, 2930 participants aged 65 and older were analyzed using 2014-2018 data from the Korean Longitudinal Study of Aging. Participants underwent assessments of handgrip strength (grip dynamometer), sensory impairment (self-reported responses), and cognitive impairment (Korean version of the Mini-Mental State Examination). Low handgrip strength, compared to normal handgrip strength, was associated with cognitive impairment. In participants with low handgrip strength, vision and hearing impairment were associated with cognitive impairment (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.06-1.75; OR 2.58, 95% CI 1.77-3.78, respectively) compared to those with normal handgrip strength. Participants with low handgrip strength and dual sensory impairment had the highest OR for cognitive impairment (OR 3.73, 95% CI 2.65-5.25). Due to the strong association of low handgrip strength and dual sensory impairment with cognitive impairment, people living with low handgrip strength and dual sensory impairment should be classified as a high-risk group for cognitive impairment and should be prioritized for interventions.

Association between self-reported medical diagnosis of depression and metabolic syndrome in a population-based study: A propensity score-matched analysis.

The aim was to compare the metabolic syndrome in adults with and without depression in Korea using the 2013-2015 Korea National Health and Nutrition Examination Survey. A cross-sectional study was conducted involving secondary data analysis. National survey data on the self-reported medical diagnosis of depression and metabolic syndrome were collected between 2013 and 2015 and released for research purposes in 2017. We conducted a propensity score-matched study that included adults (n = 494) with and without depression at a 1:1 ratio, to reduce the impact of potential confounding factors between groups. Depression was not significantly associated with changes in metabolic syndrome. However, participants with depression had significantly higher triglycerides than those without depression (p = .008), highlighting the importance of periodically checking triglycerides in depressed patients. Nurses need to check the subcomponents of metabolic syndrome in depressed patients periodically, especially regarding the management of triglycerides.

Developing an Internet-Based Trauma Recovery Nursing Intervention Based on Swanson's Theory of Caring for Trauma Recovery.

This study aimed to develop an Internet-based psychiatric nursing intervention, based on Swanson's theory of caring, that could alleviate post-traumatic stress symptoms and improve the health functioning of adults who had experienced trauma. To evaluate the appropriateness and understanding of the program content, expert advice and content validity were examined using the content validity index. To analyze the participants' responses and evaluate the appropriateness of conducting Internet-based programs, an online intervention program was implemented with five nurses between February and April 2020. The trauma recovery nursing intervention program was for adults who had experienced trauma and consisted of eight sessions, each lasting 30 min. It included a spoken audio track that was accompanied by visual prompts to provide knowledge on traumatic stress and introduce trauma recovery methods. Its online format made it convenient and widely accessible, and allowed for a low-intensity, cost-effective educational program. The program focused on providing self-help guidelines for clients to develop their mental and physical well-being. The results provide evidence that mental health nurses could develop and implement online programs to care for people who have experienced trauma. Such programs could provide trauma recovery for marginalized people unable to otherwise receive help.

Physical Comorbidity According to Diagnoses and Sex among Psychiatric Inpatients in South Korea.

People with mental disorders are susceptible to physical comorbidities. Mind-body interventions are important for improving health outcomes. We examined the prevalence of physical comorbidities and their differences by diagnoses and sex among psychiatric inpatients. The dataset, from National Health Insurance claims data, included 48,902 adult inpatients admitted to psychiatric wards for at least 2 days in 2016 treated for schizophrenia, schizotypal and delusional disorders, or mood disorders. We identified 26 physical comorbidities using the Elixhauser comorbidity measure. Among schizophrenia-related disorders, other neurological disorders were most common, then liver disease and chronic pulmonary disease. Among mood disorders, liver disease was most common, then uncomplicated hypertension and chronic pulmonary disease. Most comorbid physical diseases (except other neurological disorders) were more prevalent in mood disorders than schizophrenia-related disorders. Male and female patients with schizophrenia-related disorders showed similar comorbidity prevalence patterns by sex. Among patients with mood disorders, liver disease was most prevalent in males and third-most in females. In both diagnostic groups, liver disease and uncomplicated diabetes mellitus were more prevalent in males, and hypothyroidism in females. Mental health professionals should refer to a specialist to manage physical diseases via early assessments and optimal interventions for physical comorbidities in psychiatric patients.

Effects of social support on mental health outcomes in disasters: A cross-sectional study.

This study examined the mediating effects of social support on the association between disaster distress and mental health outcomes. We analyzed the data of 1006 participants with either direct or indirect exposure to one or more disasters. Disaster distress, social support, depression, and anxiety were significantly correlated. Multiple regression and mediation analyses with bootstrapping showed that social support was a partial mediator between disaster distress and depression, and between disaster distress and trait anxiety. It was a complete mediator between disaster distress and state anxiety. The results suggest that enhancing social support may reduce the negative effects of disaster distress on depression and anxiety. Therefore, comprehensive interventions incorporating disaster distress management and enhanced social support are essential in national disaster management policies and psychiatric and mental health nursing services for individuals who have experienced disasters.

Association of depression, pain, resilience, social support with post-traumatic stress in sexual abuse: A quantile regression approach.

Post-traumatic stress levels and factors influencing the sexual abuse period may differ between victims. This cross-sectional study conducted a secondary analysis of primary online survey data extracted from a previous study. We examined the extent of trauma (types, timing) and depression, pain, resilience, and social support associated with post-traumatic stress affecting the post-traumatic stress percentile. Among 3000 adults aged 19-65 years, 1223 adults experienced childhood sexual abuse, adulthood sexual abuse, or childhood and adulthood sexual abuse. We conducted descriptive statistics, multiple linear regression, and simultaneous quantile regression. Quantile regression analysis showed the 80th percentile groups in childhood sexual abuse, education, depression, and social support were significantly associated with post-traumatic stress. Depression was significantly and positively associated with post-traumatic stress. Resilience was significantly and negatively associated with post-traumatic stress in adulthood sexual abuse victims. Depression and pain were significantly and positively associated with post-traumatic stress in childhood and adulthood sexual abuse victims. Post-traumatic stress severity and influencing factors differed according to victims' age when the sexual abuse occurred, implying interventions should be tailored to each victim's post-traumatic stress level.

Factors affecting suicidal ideation among premenopausal and postmenopausal women.

WHAT IS KNOWN ON THE SUBJECT?: Pre- and postmenopausal women (PPW) experience changes in physical, psychological and social health. South-East Asia's female suicide rate is the highest compared with other countries, and the suicide rate of PPW in these countries continues to increase. The most influential factor in Asian women's suicidal ideation is family conflict; specifically, if PPW in South Korea cannot express their anger, it results in a culture-bound syndrome called "Hwa-Byung." However, there is a lack of research on Asian PPW. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study found differences in individual- and community-level factors affecting suicidal ideation between pre- and postmenopausal women. Individual factors that commonly affected suicidal ideation were experiencing violence, stress and depression. Individual factors that affected the suicidal ideation of premenopausal women more than postmenopausal women were religious beliefs, alcohol use and chronic disease. Community level factors affecting suicidal ideation were locational depression and locational counselling for stress in premenopausal women and locational counselling for depression in postmenopausal women. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses could help prevent suicide by developing and applying community-based programmes for PPW, considering the specific socio-economic and cultural context and characteristics of Asian women. Mental health nurses could help PPW participate in programmes by preparing various interventions such as case management, personal counselling, physical activity, home-based mental health services, cognitive behavioural therapy and digital interventions for self-management. Mental health nurses need to prepare various methods such as online, offline, individual and group methods to work effectively in any social situation. ABSTRACT: Introduction Pre- and postmenopausal women (PPW) experience physical and psychological changes with hormonal changes. Among Asian middle-aged women, family and culture affect suicidal ideation, and the suicide rate among this population is increasing. There are few existing research on suicidal ideation among Asian PPW. Aim We examined individual- and community-level factors that predict suicidal ideation among PPW. Method Large-scale panel data from 5,154 South Korean PPW aged 35-64 years were used in a series of multilevel logistic regression analyses to examine factors associated with suicidal ideation at individual and community levels. Results Among premenopausal women, religious beliefs, alcohol use, chronic disease, experience of violence, stress and depression were individual-level factors. Locational depression and locational counselling for stress were community-level factors. Among postmenopausal women, experience of violence, stress, depression and perceived health status were individual level factors, and locational counselling for depression was a community level factor. Discussion Suicidal ideation among PPW is affected by both individual and community level factors. Nurses must comprehensively determine what risk factors affect suicidal ideation through various intervention methods-including online, offline, individual and group methods-while considering socio-economic situations. Implications for Practice Mental health nurses should provide targeted biopsychosocial interventions targeting psychosocial and physical problems and promoting the use of community resources to reduce PPW's suicidal ideation.

Hair Cortisol Concentrations as a Biological Marker of Maternal Prenatal Stress: A Systematic Review.

Recently, biological markers of maternal prenatal stress, hair cortisol, along with saliva, blood, and urine cortisol, have received attention. However, it is necessary to validate measuring hair cortisol concentrations (HCC) as a biomarker of perceived stress among healthy and high-risk pregnant women. This study aimed to confirm the correlation between HCC and the perceived stress of pregnant women over 18 years of age. In this systematic review, we used various search engines to extract relevant articles using specific keywords related to pregnancy, hair cortisol, and psychological stress. Four out of 3639 studies met the inclusion criteria. We conducted a quality assessment with the help of three independent reviewers using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. The correlation between HCC and perceived stress was confirmed in one study. There was only one study on hair washing, shampoo, conditioner, and hair structure that could affect hair samples. In four studies, hair samples differed in length, methods of storage, and laboratory analysis. The review was limited to confirming the relationship between HCC and perceived stress in pregnant women based on the current evidence. Studies on hair cortisol need regulated and standardized methods for collection, storage, and analysis of hair samples.

Prevalence of Traumatic Experiences in South Korean Adults.

Although a variety of traumatic experiences can impact health over the lifetime, little is known about the prevalence of such experiences in South Korea. The purpose of this study was to examine the frequencies of traumatic experiences and their differences by gender and age. South Korean adults (N = 3000) aged 19-65 years completed a self-report survey assessing childhood and adulthood trauma and sociodemographic characteristics. Overall, 79.5% of the participants reported at least one traumatic experience in adulthood. Unemployment or job loss and academic or work difficulties were commonly reported. The most distressing adulthood trauma was the unexpected death of a loved one, followed by diseases in loved ones. Childhood trauma was higher in males than in females. In males, childhood trauma was higher at a younger age, but in females, it was higher at an older age. Adulthood trauma was higher in females than in males and at older ages for both males and females. The current findings demonstrate the differences in traumatic experiences by gender and age in the South Korean general population. These results could help improve assessment of and targeted intervention for psychological trauma through trauma-informed strategies in public health practice.

Comparative Study of Dietary Patterns by Living Arrangements: The Korea National Health and Nutrition Examination Survey (KNHANES) 2013-2015.

This study aimed to identify the dietary patterns of Koreans, comparing them according to their living arrangements, and to determine factors associated with the patterns. We analyzed nutritional data of 6719 Korean adults aged 19-64 years from the 2013-2015 Korea National Health and Nutrition Examination Survey using the exploratory factor and hierarchical and k-means cluster analyses. We used multinominal logistic regression to compare factors associated with each dietary pattern. We identified three dietary patterns based on meal preference and dessert type: "traditional meal with healthy dessert", "meal only", and "unhealthy dessert" (Kaiser-Meyer-Olkin = 0.90, Bartlett's test of sphericity p < 0.001). The "unhealthy dessert" dietary pattern was more frequent in people living alone (51.7%) than in those living with others (41.8%). Weight control, dining out, eating breakfast, and sleep were significantly associated with the "meal only"; eating breakfast was associated with the "unhealthy dessert" dietary pattern among those living alone. Lifestyle factors were associated with unhealthy dietary patterns in Korean adults living alone, warranting the need for a healthy diet and promotion of modifiable health behaviors for this subgroup. Thus, clinicians must provide comprehensive assessments and multidimensional interventions while considering lifestyle factors and unhealthy dietary patterns to improve the health status of them.

The Effectiveness of Psychological Interventions for Women Traumatized by Sexual Abuse: A Systematic Review and Meta-Analysis.

Women traumatized by sexual abuse as children or adults experience psychological disorders, such as post-traumatic stress, depression, anxiety, and social adjustment. The published research includes a broad array of studies on psychological interventions intended to ease their symptoms. This study systematically examined the specific effects of psychological interventions for women traumatized by sexual abuse and statistically evaluated interventions by calculating effect sizes in a meta-analysis. A literature search was conducted of electronic databases of journals, gray literature and Clinical Research Information Service. Medical Subject Heading terminology, text words, and logical operators were applied, and 2,029 articles published in English or Korean were retrieved. Inclusion criteria were full-text articles on randomized controlled trials in which: (1) the subjects were women 18 years or older who had been sexually assaulted or raped; (2) all types of exclusively psychological treatment were used; (3) comparisons were mediated or routinely managed without psychosomatic treatment; (4) interventions did not target patients with chronic mental illnesses or neurocognitive dysfunctions; and (5) the studies were not on animals, empirical research, cohorts, research protocols, or integrated literature reviews. Ten articles fully met the inclusion criteria. The main findings were: (1) interventions had long-term effects on post-traumatic stress reduction, (2) effects on depression were effective only 3 months post-intervention, and (3) there were no follow-up effects on anxiety reduction or social adjustment improvement. The types of therapeutic intervention, delivery mode, number and duration of sessions, and number of weeks varied.

Functional Health in Korean Middle-Aged Women with Poor Sleep Quality.

PURPOSE: To develop and test a structural model of functional health in middle-aged women based on the theory of unpleasant symptoms. METHODS: The direct and indirect effects of menopause status, childhood trauma, post-traumatic stress, social support, and sleep quality on functional health of 264 Korean women were examined. FINDINGS: Menopause status and poor sleep quality had a negative direct effect and social support had a positive direct effect on functional health. Menopause status had a negative indirect effect on functional health through poor sleep quality. CONCLUSIONS: Biopsychosocial nursing intervention programs need to be developed to improve functional health in middle-aged women. IMPLICATIONS FOR NURSING PRACTICE: It is important to mediate quality of sleep to improve functional health in middle-aged women. 목적 불쾌증상 이론을 바탕으로 중년 여성의 건강기능을 평가하기 위함이다. 방법 264명의 한국 여성을 대상으로 건강기능에 영향을 미치는 폐경, 아동기 외상, 외상 후 스트레스, 사회적 지지의 직ㆍ간접적 영향을 확인하였다. 결과 폐경과 낮은 수면의 질은 건강기능에 부적 영향을 미쳤으며, 사회적 지지는 건강기능에 정적 영향을 미쳤다. 폐경은 건강기능에 간접적 영향을 미쳤다. 결론 중년여성의 건강기능을 증진하기 위해 신체ㆍ심리ㆍ사회적 요인을 고려한 통합적 중재가 필요하다. 간호실무 적용점: 중년여성의 건강기능을 유지하기 위해 수면의 질을 중재하는 것이 중요하다.