Effects of Virtual Reality-Based Cognitive Rehabilitation in Stroke Patients: A Randomized Controlled Trial.

During the process of recovering functional ability after damage caused by a stroke, it is important to restore cognitive function via cognitive rehabilitation. To achieve successful rehabilitation, it is important for patients to have a sense of efficacy in their ability to manage their disease well. Therefore, a virtual reality-based cognitive rehabilitation program based on self-efficacy theory was developed, and its effects were compared with conventional and computer-assisted cognitive rehabilitation. The virtual reality-based cognitive rehabilitation program consisted of sessions lasting 30 min each five days a week for eight weeks. After applying the virtual reality-based cognitive rehabilitation program, there were significant differences in group-by-time interactions regarding stroke self-efficacy, cognitive function, visual perception, activities of daily living, and health-related quality of life. In addition, there were significant group differences among the three groups in terms of stroke self-efficacy and health-related quality of life. In conclusion, our virtual reality-based cognitive rehabilitation program developed based on self-efficacy theory is effective for inpatients with stroke and improves their stroke self-efficacy, cognitive function, visual perception, activities of daily living, and health-related quality of life.

Effects of Stroke Rehabilitation Using Gait Robot-Assisted Training and Person-Centered Goal Setting: A Single Blinded Pilot Study.

Many stroke survivors have difficulties due to the mobility and activities required in daily living. A walking impairment negatively affects the independent lifestyle of stroke patients, requiring intensive post-stroke rehabilitation. Therefore, the purpose of this study was to examine the effects of stroke rehabilitation using gait robot-assisted training and person-centered goal setting on mobility, the activities of daily living, stroke self-efficacy, and health-related QoL in stroke patients with hemiplegia. An assessor-blinded quasi-experimental study with a pre-posttest nonequivalent control group was used. Participants who were admitted to the hospital with a gait robot-assisted training system were assigned to the experimental group, and those without gait robots were assigned to the control group. Sixty stroke patients with hemiplegia from two hospitals specialized in post-stroke rehabilitation participated. Stroke rehabilitation using gait robot-assisted training and person-centered goal setting for stroke patients with hemiplegia was conducted for a total of six weeks. There were significant differences between the experimental group and control group in the Functional Ambulation Category (t = 2.89, p = 0.005), balance (t = 3.73, p < 0.001), Timed Up and Go (t = -2.27, p = 0.027), Korean Modified Barthel Index (t = 2.58, p = 0.012), 10 m Walking test (t = -2.27, p = 0.040), stroke self-efficacy (t = 2.23, p = 0.030), and health-related quality of life (t = 4.90, p < 0.001). A gait robot-assisted rehabilitation using goal setting for stroke patients with hemiplegia improved gait ability, balance ability, stroke self-efficacy, and health-related quality of life in stroke patients.

Effectiveness of a Mobile Wellness Program for Nurses with Rotating Shifts during COVID-19 Pandemic: A Pilot Cluster-Randomized Trial.

Nurses with rotating shifts, including night shifts, have suffered from low physical activity during the COVID-19 pandemic and lower sleep quality due to the disruption of their circadian rhythm. This study aimed to develop and examine the effectiveness of a mobile wellness program on daily steps, sleep quality, exercise self-efficacy, intrinsic motivation for exercise, self-rated fatigue, and wellness. A cluster randomized controlled trial design was used to examine the effectiveness of the mobile wellness program for nurses with rotating shifts. Sixty nurses from one university hospital participated and were allocated to an intervention group and a control group. The intervention group received a 12-week mobile wellness program to improve their physical activity and sleep quality, and the control group was only given a Fitbit to self-monitor their health behaviors. There were significant differences between the two groups in daily steps (p = 0.000), three components (subjective sleep quality, sleep disturbance, daytime dysfunction) of the PSQI, exercise self-efficacy, intrinsic motivation for exercise, and wellness. In conclusion, this study provides meaningful information that the mobile wellness program using Fitbit, online exercise using Zoom, online health coaching on a Korean mobile platform, and motivational text messages effectively promoted physical activity and sleep quality for nurses with rotating shifts during the COVID-19 pandemic.

Development and Effectiveness of a Community Capacity Building Program for the Wellness of Traditional Marketplace Merchants: A Pilot Study.

Merchants in the traditional marketplace are exposed to poor working conditions, such as long working hours, musculoskeletal stress, lack of physical activity, irregular meal times, and nutritional imbalance. This study aimed to develop a community capacity-building program for the wellness of traditional marketplace merchants and examine its effectiveness. A total of 60 merchants from two traditional markets were allocated to an experimental group and control group. The program consisted of four sections: Training wellness leaders in the traditional marketplace, wellness, organizing wellness committee, and promoting wellness partnerships. The program was conducted over 12 weeks. Significant differences were observed in week 12 between the experimental and control groups in leadership (p = 0.010), health knowledge (p < 0.001), health self-efficacy (p = 0.016), wellness (p = 0.001), and community capacity (p = 0.038). The community capacity-building program for the wellness of traditional marketplace merchants was effective in improving marketplace merchants' leadership, health knowledge, health self-efficacy, wellness, and community capacity. Therefore, it is recommended to actively utilize this community capacity program for market merchants.

Predicting Posttraumatic Growth among Firefighters: The Role of Deliberate Rumination and Problem-Focused Coping.

Exposure to work-related traumatic incidents in firefighters may result in positive psychological changes which are termed "posttraumatic growth". This study aimed to construct structure equation modeling based on the model of posttraumatic growth in firefighters. Methods: A total of 226 firefighters who had experienced a work-related traumatic incident participated. The participants from three municipal fire departments and seven fire stations completed an anonymous survey asking about extraversion, optimism, calling in the workplace, problem-focused coping, deliberate rumination, and posttraumatic growth. The model fit indices were suitable for the recommended level. Seven of the 11 paths established in the initial hypothetical model were identified. The variables of deliberate rumination, problem-focused coping, and extraversion had a significant effect on the posttraumatic growth of firefighters, with an explanatory power of 38.7%. The findings show that it is important to develop strategies to enhance deliberate rumination and problem-focused coping for firefighters after work-related traumatic events.

Exploring the Relationships between Posttraumatic Growth, Wisdom, and Quality of Life in Older Cancer Survivors.

Objective: The number of older cancer survivors is steadily rising with a growing aging population, and a great interest in evaluating the quality of life is emerged. Although understanding how to improve the quality of life in older cancer survivors is critical as the number of older survivors continues to grow in communities, little is known about empirical evidence regarding predictors of the quality of life in older cancer survivors. This study aimed to examine relationships between posttraumatic growth, wisdom, and quality of life in older cancer survivors. Methods: A convenience sample of older cancer survivors after completing cancer treatments (n=121) participated from one public health center, and they filled out self-report questionnaires on measures of posttraumatic growth, wisdom, and quality of life. Results: As results of multiple regression analysis, the most significant factor on each domain of the quality of life has shown that higher levels of subjective economic status were associated with significant improvement of four domains of quality of life, and wisdom and posttraumatic growth were associated with significant improvement in social/family well-being. Conclusion: This study highlights predictors of each domain of quality of life that subjective economic status, posttraumatic growth and wisdom significantly affected the quality of life in older cancer survivors. Findings indicate that psychological interventions need to be developed and implemented for older cancer survivors to prevent long-term effects of cancer and to increase their quality of life. For improving their quality of life, primary care providers or community health professionals need to develop tailored interventions, such as home-based cancer survivorship programs.

Gender Differences in Predictors of Physical Activity among Korean College Students Based on the Health Promotion Model.

Aim: Despite the numerous physical and psychological benefits of physical activity (PA), the prevalence of achieving PA recommendations decreases in college students. Therefore, this study was conducted to identify factors influencing PA in male and female college students based on the Health Promotion Model. Methods: A quantitative, cross-sectional research design was used to investigate factors influencing PA among male and female college students. A convenience sample of 264 Korean students was recruited from three colleges. Participants completed measures of physical activity, perceived benefits/barriers to PA, PA self-efficacy, activity-related affect, and peer support. Results: A multiple regression analysis indicated that the factors affecting PA in male college students were PA self-efficacy and subjective economic status, while the factors affecting PA in female students were PA self-efficacy, subjective health status, activity-related affect, and peer support. Conclusions: School health centers or wellness centers need to develop exercise self-efficacy enhancement programs to provide motivation for PA among college students. It might also be necessary to develop a customized PA program that considers gender differences.

The Association of the Exposure to Work-Related Traumatic Events and Work Limitations among Firefighters: A Cross-Sectional Study.

Many firefighters suffering from traumatic events while on duty participate in the work force. However, the impact of work-related traumatic events on work performance is unclear. To address this issue, we administered a work-related traumatic event experience survey, the health-related work limitations questionnaire, the Korea Depression Scale, and the World Health Organization quality of life assessment to firefighters from four cities in Korea. The health-related work limitations questionnaire measured limitations in their ability to perform three specific work demands-physical, psychosocial, and environmental. Of 685 firefighters enrolled in the study, 618 (90.2%) were included in the final analyses. Their mean age ± standard deviation (SD) was 41.1 ± 8.0 years and mean employment period ± SD was 163.0 ± 101.2 months. A large percentage of participants reported they had experienced work-related traumatic events. Among the firefighters, the total work limitation prevalence was 21.5%, 16.8% of them were limited in their abilities to perform physical work demands, 15.5% were limited in performing psychosocial work demands, and 13.8% were limited in their abilities to function without difficulty within the ambient work environment. Based on multivariable logistic regression, with having work-related traumatic event experience of a threat or injury to self, the odds ratio (OR) of having work limitations in physical (OR = 3.32, 95% CI = 1.17⁻9.41), psychosocial (OR = 3.05, 95% CI = 1.08⁻8.61), environmental (OR = 4.89, 95% CI = 1.66⁻14.40) work demands, and total work limitation (OR = 3.73, 95% CI = 1.44⁻9.68) increased significantly. With experiences of treating fatalities or injured patients, the OR of total work limitation increased significantly (OR = 2.07, 95% CI = 1.09⁻3.91). We demonstrated a relationship between the firefighters' exposure to work-related traumatic events and their work limitations. A professional care management system for firefighters to prevent and manage work-related traumatic events should be developed in order to protect and improve their performance ability.

Effectiveness of a Workplace Smoking Cessation Program based on Self-determination Theory Using Individual Counseling and Tailored Text Messaging: A Pilot Study.

PURPOSE: Adverse health effects of smoking could be made worse by worker's tobacco use, and combining tobacco use with occupational hazards could enhance the likelihood of occupational disease and injury. This study was aimed to develop a workplace smoking cessation program based on self-determination theory (SDT) and then to examine the effectiveness of the program. METHODS: A quasi-experimental design with nonequivalent control group pretest-posttest design was used. An intervention group (n = 30) received a smoking cessation program using individual counseling and tailored text messaging based on SDT during 12 weeks. Participants in the control group (n = 30) received a smoking cessation leaflet and telephonic follow-up for 3 times. RESULTS: At 6 and 12 weeks, there were significant differences between the two groups on autonomous regulation, perceived competence, nicotine dependence, tobacco abstinence rate, and exhaled carbon monoxide concentration. At 12 weeks, the abstinence rate in the intervention group was 96.7%, whereas that in the control group was 12.9%. CONCLUSION: SDT-based workplace smoking cessation program using individual counseling and tailored text messaging is effective in encouraging autonomous regulation and competence for workers.

The Effects of a Mobile Wellness Intervention with Fitbit Use and Goal Setting for Workers.

Background and Introduction: There is strong evidence that worksite wellness programs can significantly improve the health profile of participating workers. To date, little is known about research on the effects of mobile wellness interventions in worksite settings. Furthermore, no studies have been conducted to evaluate mobile wellness interventions with activity trackers and tailoring strategies for physically inactive workers in manufacturing companies. This study aimed to examine the effects of a mobile wellness intervention with Fitbit and goal setting using brief counseling and text messaging among workers. Materials and Methods: A total of 79 (n = 79) workers from large manufacturing companies were allocated into an experimental group (n = 41) and a control group (n = 38). All participants were asked to wear an activity tracker (Fitbit Charger HR) during all waking hours for 5 weekdays. Participants in the experimental group received Fitbit, daily motivational text messaging, and biweekly counseling with a specifically designed workbook for 12 weeks, whereas Fitbit was only provided to the control group. Results: At the 12-week measurement, there were significant differences between the experimental group and control group on wellness (p < 0.001), physical activity behavior (p < 0.001), daily walking steps (p < 0.001), and physical activity self-efficacy (p < 0.001). Discussion and Conclusions: Although Fitbit facilitates an individual's activities by providing information about daily steps, the tracker itself, without additional goal-setting techniques, may be insufficient to encourage behavior change. These findings indicate that the mobile wellness intervention with Fitbit and goal setting using brief counseling and tailored text messaging is more effective for physically inactive workers.

Evaluation of factors related to glycaemic control among South Korean patients with type 2 diabetes.

AIMS: To examine specific self-care behaviours, depression, and diabetes-related stress among South Korean patients with type 2 diabetes and to evaluate whether these factors are related to glycaemic control. METHODS: This cross-sectional study included 171 patients with type 2 diabetes who visited an endocrinology clinic. A structured questionnaire and electronic medical records were used to collect data regarding self-care behaviours, depression, diabetes-related distress, and glycaemic control between May 2015 and July 2015. RESULTS: Compared with the group with good glycaemic control, the group with poor glycaemic control had significantly lower values for medication adherence and significantly greater values for regimen-related distress. Depression was not significantly associated with glycaemic control. In logistic regression analysis, only medication adherence was independently associated with glycaemic control. CONCLUSIONS: Medication adherence should be continuously emphasized and monitored in clinical practice to effectively manage glycaemic control among patients with type 2 diabetes. Furthermore, consideration of diabetes-related distress may help improve glycaemic control among patients with type 2 diabetes.

[Development of a Wellness Index for Workers].

PURPOSE: The purpose of this study was to develop a wellness index for workers (WIW) and examine the validity and reliability of the WIW for assessing workers' wellness. METHODS: The developmental process for the instrument included construction of a conceptual framework based on a wellness model, generation of initial items, verification of content validity, preliminary study, extraction of final items, and psychometric testing. Content validity was verified by 4 experts from occupational health nursing and wellness disciplines. The construct validity, convergent validity and discriminant validity were examined with confirmatory factor analysis. The reliability was examined with Cronbach's alpha. The participants were 494 workers from two workplaces. RESULTS: Eighteen items were selected for the final scale, and the results of the confirmatory factor analysis supported a five-factor model of wellness with acceptable model fit, and factors named as physical · emotional · social · intellectual · occupational wellness. The convergent and discriminant validity were also supported. The Cronbach's alpha coefficient was .91. CONCLUSION: The results indicate that the WIW is a valid and reliable instrument to comprehensively assess workers' wellness, and to provide basic directions for developing workplace wellness program.

Development and validation of an instrument to assess knowledge and skills of evidence-based nursing.

AIMS AND OBJECTIVES: To develop an objective instrument to measure nurses' entry-level knowledge of and skills in evidence-based practice, and to evaluate the validity and reliability of the instrument. BACKGROUND: To promote evidence-based practice in nursing, nurses should initially receive education about evidence-based practice knowledge and learn the skills, and this should be followed by measurement with an instrument that was developed to evaluate the extent to which they are prepared to use evidence-based practice knowledge and skills. Although some self-report instruments have been developed to measure evidence-based practice in nursing, an objective instrument to evaluate nurses' evidence-based practice knowledge and skills is not available at present. DESIGN: A methodological study. METHODS: This study was conducted in two stages: the instrument development and its psychometric evaluation, including its validity and reliability. An instrument, 'Knowledge and Skills of Evidence-based Nursing,' was developed. Content validity was assessed by five experts in evidence-based nursing, and the construct validity was evaluated by the known-groups method. Reliability was examined with internal consistency reliability and inter-rater reliability. RESULTS: A content validity index >0·80 was achieved. For construct validity, there were statistically significant differences between the evidence-based practice and nonevidence-based practice groups in total scores and in the scores on each subscale of the Knowledge and Skills of Evidence-based Nursing. Cronbach's alpha was 0·96, and the inter-rater reliability was excellent. CONCLUSIONS: The Knowledge and Skills of Evidence-based Nursing is a valid and reliable instrument for objectively assessing nurses' evidence-based practice knowledge and skills; it is quick to complete and to score the answers. RELEVANCE TO CLINICAL PRACTICE: Because the Knowledge and Skills of Evidence-based Nursing objectively assesses nurses' evidence-based practice knowledge and skills, it can be used to examine the effects of evidence-based practice education. Moreover, the Knowledge and Skills of Evidence-based Nursing may contribute to the promotion of evidence-based practice projects in clinical settings because it can measure the extent to which nurses are prepared to use their evidence-based practice knowledge and skills.

[Effectiveness of a self-management program using goal setting based on a G-AP for patients after a stroke].

PURPOSE: This study was conducted to develop a self-management program using goal setting for patients after a stroke. The program was based on a theory-based Goal setting and Action Planning framework (G-AP), and the effectiveness of the program was examined. METHODS: A non-equivalent control group pretest-posttest design was used. The experimental group (n=30) received the self-management program using goal setting based on the G-AP over 7 weeks. The education was delivered individually with a specifically designed stroke workbook. The control group (n=30) received only patient information leaflets about stroke. RESULTS: There were significant differences between the two groups. Stroke knowledge, self-efficacy, and health behavior compliance were significantly higher (all p<.001), and hospital anxiety (p<.001) and depression (p<.001) were significantly lower in the experimental group compared to the control group. CONCLUSION: This self-management program using goal setting based on a G-AP was found to be useful and beneficial for patients in stroke rehabilitation settings.

[Effects of a smoking cessation program including telephone counseling and text messaging using stages of change for outpatients after a myocardial infarction].

PURPOSE: This study was done to identify effects of a smoking cessation program including telephone counseling and text messaging using stages of change for outpatients who have had a myocardial infarction (MI). METHODS: This research was a quasi-experimental design with a nonequivalent control group pretest-posttest. The participants were 48 outpatients (experimental group=24, control group=24) recruited from one university hospital. They were randomly assigned to one of two groups: (a) an experimental group with telephone counseling (once a week) and text messaging (five times a week) using stages of change, and (b) a control group with traditional telephone counseling (once a month). Efficacy of the intervention was measured by comparing the two groups on smoking-related variables at 3 weeks and 12 weeks. RESULTS: At the 3-week and 12-week measurements, there were significant differences between the experimental and control groups on smoking cessation self-efficacy (p<.001), nicotine dependence (p<.001), CO levels (p<.001), and smoking cessation rates (p<.001). CONCLUSION: The results indicate that the smoking cessation program including telephone counseling and text messaging using stages of change is effective for outpatients after a MI. Further attention should be paid to the intensity of the smoking cessation program and periods for long-term follow-up.

Relationships among subjective social status, weight perception, weight control behaviors, and weight status in adolescents: findings from the 2009 Korea Youth Risk Behaviors Web-Based Survey.

BACKGROUND: This study identified relationships among subjective social status (SSS), weight perception, weight control behaviors, and weight status in Korean adolescents using nationally representative data collected from the 2009 Korea Youth Risk Behaviors Web-Based Survey. METHODS: Data from 67,185 students aged 12-18 years were analyzed. Relationships among SSS, weight perception, and weight control behaviors in boys and girls were examined using chi-square. Logistic regression analysis was performed with adjusting school grade and place of residence to assess potential associations between multiple variables and overweight students. RESULTS: Lower SSS was associated with a significant risk of being overweight in girls, but not in boys. Of particular interest, overestimation and underestimation coexist within boys, whereas girls predominantly tended to overestimate their weight status. Inaccurate weight perception and unhealthy weight control behaviors were significantly associated with the risk of being overweight in both boys and girls. CONCLUSIONS: Considering the results of this study showing sex differences in weight perception and weight control behaviors, sex-specific overweight prevention programs are needed to achieve accurate weight perception and healthy weight control behaviors.

Prevalence and associated risk factors of the metabolic syndrome in the Korean workforce.

The purposes of this study were to estimate the prevalence of metabolic syndrome and to investigate the risk factors associated with metabolic syndrome in Korean workers. This is a secondary data analysis study using the data set from the Korean National Health and Nutrition Examination Survey IV. A total of 1,545 workers over 20 yr of age were included in this analysis. The prevalence of metabolic syndrome was determined using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Waist circumference was based on the study of obesity guidelines. The overall prevalence of metabolic syndrome among Korean workers was 21.0% (28.5% men, 11.8% women). In a multiple logistic regression analysis, male workers with high job control and heavy alcohol consumption were significantly associated with metabolic syndrome. For women, low job control and current smoking increased the risk of metabolic syndrome. The risk of developing metabolic syndrome is strongly associated with level of job control in both male and female workers. These findings suggest that behavioral lifestyle modifications, including smoking cessation, moderating alcohol consumption, and controlling work-related factors and job control in the workplace should be considered for the prevention and management of metabolic syndrome in Korean workers.

Prevalence of overweight and obesity in children with intellectual disabilities in Korea.

BACKGROUND: Overweight and obesity in children with intellectual disabilities may be a major health threat. The purpose of this study was to examine the prevalence of overweight and obesity in Korean children with intellectual disabilities aged 7-18 years who did not have specific genetic syndromes or physical disabilities. MATERIALS AND METHODS: Participants were 2,404 children with intellectual disabilities aged 7-18 years attending thirteen special schools in Korea. Data from school health records were analysed using SAS (version 9.2). The differences between boys and girls were assessed for children's height and weight using t-tests and for children's age and weight status, such as using Chi-Square (χ(2) ) test. The relationships between children's weight status, age and gender were reassessed using Chi-Square (χ(2) ) test, and strengths of the relationships were measured using Gamma coefficient. RESULTS: Approximately one-quarter of children with intellectual disabilities were either overweight or obese. Children's gender was significantly associated with their weight status, such that overweight and obesity were more prevalent in girls than in boys, specifically girls aged 15-18 years. There was a positive relationship between age and the prevalence of overweight and obesity in children for both boys and girls. CONCLUSIONS: The high rates of overweight and obesity in children with intellectual disabilities highlight the need for interventions to help children achieve healthy weight. Before conducting weight management interventions, identifying risk factors that influence weight status in children with intellectual disabilities is an important step.

HeartCode BLS with voice assisted manikin for teaching nursing students: preliminary results.

The purpose of this study was to evaluate the effectiveness of HeartCode BLS, a self-directed, computer-based course for obtaining basic life support (BLS) certification. For part 2 of the course, students learned and practiced their cardiopulmonary resuscitation (CPR) psychomotor skills on a voice assisted manikin (VAM). Students from 10 schools of nursing were randomly assigned to two types of CPR training: HeartCode BLS with VAM or the standard, instructor-led (IL) course with manikins that were not voice assisted; 264 students trained using HeartCode BLS and 339 had an IL course. When students passed their respective courses and were certified in BLS, their CPR skills were tested using the Laerdal PC SkillReporting System. Students who trained using HeartCode BLS and practiced their CPR skills on VAMs were significantly more accurate in their ventilations, compressions, and single-rescuer CPR than students who had the standard, IL course with regular manikins.

Advantages and barriers to use of HeartCode BLS with voice advisory manikins for teaching nursing students.

Nursing students are expected to have competency in cardiopulmonary resuscitation (CPR): they may care for patients at risk for cardiac arrest and may encounter other emergency situations in their clinical practice. In the United States, students may take a basic life support (BLS) course prior to entering a nursing program or beginning their clinical experience. Extensive research has shown, however, that CPR knowledge and skills decline rapidly, within weeks of completing a course. The purpose of this paper is to describe advantages and barriers to the use of HeartCode BLS with voice advisory manikins for learning and practicing CPR psychomotor skills in a nursing education program.