Influencing factors of pressure injury healing in an acute care setting: A retrospective cohort study.

AIM: This study aimed to investigate the factors that influence healing during acute care hospitalization by examining the differences in pressure injury (PI) status between admission and discharge. MATERIAL AND METHODS: A total of 371 patients who met the study's inclusion criteria were divided into two groups (aggravated or improved) based on the PI status observed at admission and discharge. We used bivariate analyses to compare demographics and clinical factors associated with wound severity and aggravation/improvement of wound condition. Using multiple logistic regression, we identified and examined independent predictors for significant association with aggravation/improvement of the wound status. RESULTS: The prevalence rate of PI at acute hospital admission was 12.5%. By the time of discharge, only 5.4% of PI patients had improved PI, whereas 12.6% had aggravated PI. The significant aggravating factors of PI during acute care hospitalization were the patient's consciousness level, use of foley catheter, creatinine level, and Braden Scale scores (p < .05). Residential place prior to admission were found to be associated with the healing. CONCLUSIONS: Nurses providing prophylactic management require close attention to patients who are admitted from long-term facilities to prevent aggravation of PI during acute care hospitalization.

Enhancing the sialylation of recombinant EPO produced in CHO cells via the inhibition of glycosphingolipid biosynthesis.

Sialylation regulates the in vivo half-life of recombinant therapeutic glycoproteins, affecting their therapeutic efficacy. Levels of the precursor molecule cytidine monophospho-N-acetylneuraminic acid (CMP-Neu5Ac) are considered a limiting factor in the sialylation of glycoproteins. Here, we show that by reducing the amount of intracellular CMP-Neu5Ac consumed for glycosphingolipid (GSL) biosynthesis, we can increase the sialylation of recombinant human erythropoietin (rhEPO) produced in CHO cells. Initially, we found that treating CHO cells with a potent inhibitor of GSL biosynthesis increases the sialylation of the rhEPO they produce. Then, we established a stable CHO cell line that produces rhEPO in the context of repression of the key GSL biosynthetic enzyme UDP-glucose ceramide glucosyltransferase (UGCG). These UGCG-depleted cells show reduced levels of gangliosides and significantly elevated levels of rhEPO sialylation. Upon further analysis of the resulting N-glycosylation pattern, we discovered that the enhanced rhEPO sialylation could be attributed to a decrease in neutral and mono-sialylated N-glycans and an increase in di-sialylated N-glycans. Our results suggest that the therapeutic efficacy of rhEPO produced in CHO cells can be improved by shunting intracellular CMP-Neu5Ac away from GSL biosynthesis and toward glycoprotein sialylation.

Factors related to satisfaction with long-term care services among low-income Korean elderly adults: A national cross-sectional survey.

BACKGROUND: With the growing demand for long-term care (LTC) services, it is increasingly important to explore experience with care. This study examined care satisfaction in a nursing home and at home among low-income elders in South Korea. METHODS: This cross-sectional study was conducted with 246 elderly recipients of welfare benefits using a proportional stratified sampling method. Two self-reported versions of a questionnaire developed for users of nursing home care and homecare were used. RESULTS: Those at home reported higher care satisfaction than those in nursing homes did. Both users of nursing home care and homecare were less satisfied with the food served. Users of nursing homes had comparatively less satisfaction regarding the daily activities available to them and less autonomy concerning their care decisions. Factors that influenced satisfaction with nursing home care and homecare were the quality of caregivers, care facilities, and physical wellbeing. CONCLUSIONS: An approach focused on improving the quality of the care facilities and caregivers could help enhance care satisfaction among low-income Korean elders receiving LTC.

Gender differences in metabolic syndrome components among the Korean 66-year-old population with metabolic syndrome.

BACKGROUND: Gender is thought to be an important factor in metabolic syndrome and its outcomes. Despite a number of studies that have demonstrated differences in metabolism and its components that are dependent on gender, limited information about gender differences on the characteristics of metabolic syndrome and its components is available regarding the Korean old adult population. This study aimed to identify gender differences in characteristics of the metabolic syndrome and other risk factors for cardiovascular disease. METHODS: Secondary analysis of data from a nationwide cross-sectional survey for health examination at the time of transitioning from midlife to old age was performed. Multiple logistic regression models were used to estimate adjusted odds ratios and 95% confidence intervals for gender differences among the Korean 66-year-old population with metabolic syndrome. RESULTS: Gender differences in metabolic syndrome components that contributed to the diagnosis of metabolic syndrome were identified. In males, the most common component was high blood sugar levels (87.5%), followed by elevated triglyceride levels (83.5%) and high blood pressure (83.1%). In females, the most commonly identified component was elevated triglyceride levels (79.0%), followed by high blood sugar levels (78.6%) and high blood pressure (78.5%). Gender differences for other risk factors for cardiovascular disease, including family history, health habits, and body mass index were observed. CONCLUSIONS: Gender-specific public health policies and management strategies to prevent cardiovascular disease among the older adult population should be developed for Koreans undergoing the physiological transition to old age.

Historical overview of community health practitioners in Korea.

The Korean government introduced CHPs (Community Health Practitioners) as front-line primary health care providers to address the health disparity between urban and rural areas. Through their dedicated contribution over last 30 years, the CHPs have improved Korea's public health through the successful control of high birth rates, a lowered maternal and infant mortality rate in the 1980s, eradication of parasitic infection, and containing many communicable diseases including hepatitis B. However, rapid changes in the health care environment and demands for health care among rural residents have required changes in the roles and functions of the CHPs. They are challenged by fundamental changes in the public health system addressing various health issues due to a rapidly aging society, pandemic of chronic disease, new infectious disease, and climate changes. CHPs should continuously transform their roles and functions to establish a lifelong health management system. This article presents a historical overview of the CHP system and their tasks and activities. Also, recent challenges that CHPs are facing and strategies to overcome those challenges will be discussed. This historical overview will be informative for other developing countries in resolving their own public health problems.

Globoside promotes activation of ERK by interaction with the epidermal growth factor receptor.

BACKGROUND: Globoside (Gb4), a globo-series glycosphingolipid (GSL), has been characterized as a stage-specific embryonic antigen (SSEA), and is highly expressed during embryogenesis as well as in cancer tissues. However, the functional role and molecular mechanism of Gb4 are so far unknown. METHODS: GSLs were preferentially inhibited by treatment with D-threo-1-ethylenedioxyphenyl-2-palmitoylamino-3-pyrrolidino-1-propanol (EtDO-P4), a nanomolar inhibitor of GSL synthesis, in two carcinoma cell lines, HCT116 and MCF7. The effect of EtDO-P4 was examined by MTT assay, FACS, wound assay, western blotting, and RTK array analysis. The functional role of Gb4 was determined by the exogenous addition of various GSLs, and an assay utilizing GSL-coated latex beads. RESULTS: Both cell lines contained higher levels of neutral GSLs than of sialic acid-containing GSLs. Gb4 was one of the major neutral GSLs. The depletion of total GSLs caused significant reduction of cell proliferation, but had less effect on cell apoptosis or motility. EtDO-P4 treatment also suppressed activation of the epidermal growth factor receptor (EGFR)-induced ERK pathway and various receptor tyrosine kinases (RTKs). The reduced activation of ERK was restored by the exogenous addition of Gb4, but not by the addition of gangliosides (GM1, GM2, GM3, and GD1a). The GSL-coated bead assay indicated that Gb4 forms a complex with EGFR, but not with other RTKs. Taken together, Gb4 promotes activation of EGFR-induced ERK signaling through direct interaction with EGFR. GENERAL SIGNIFICANCE: A globo-series GSL, Gb4, promotes EGFR-induced MAPK signaling, resulting in cancer cell proliferation. These findings suggest a possible application of Gb4 in cancer diagnostics and drug targeting.

Relationship of job satisfaction with perceived organizational support and quality of care among South Korean nurses: a questionnaire survey.

BACKGROUND: The International Hospital Outcomes Study found that organizational/managerial support for nursing has a pronounced effect on nurses' job dissatisfaction, burnout and quality of care. However, these findings have not been validated in non-Western countries using the same study method and instrument. OBJECTIVES: The objectives of this study were to: (a) examine associations between job satisfaction and burnout, organizational support and quality of care reported by South Korean nurses, (b) identify the best predictors of job satisfaction among South Korean nurses through multivariate modeling and (c) compare findings of this study with those from the International Hospital Outcomes Study. RESEARCH METHOD: This replication study used a cross-sectional survey design. The Pennsylvania Registered Nurse Survey used in the International Hospital Outcomes Study (IHOS) was administered to 496 registered nurses working at 23 acute hospitals in South Korea. A statistical model of job satisfaction was developed using logistic regression. RESULTS: Job dissatisfaction was positively correlated to total burnout scores (r=.42, p<.001) and lack of organizational support (r=.36, p<.001). Multivariate analysis found that job satisfaction was significantly associated at the level of 0.05 with total burnout scores, amount of organizational support and satisfaction with nurse identity, with odds ratios of .92 (p<.001), 1.04 (p<.01) and 11.93 (p<.001), respectively. Korean nurses reported low quality of care in their practice setting and were less confident in their patients' ability of self-management after discharge. Yet despite a high patient-to-nurse ratio (22 patients per nurse), Korean nurses had a higher job satisfaction rate (68.8%) and lower burnout scores (35.7) than their counterparts in the International Hospital Outcomes Study. CONCLUSION: The high patient-to-nurse ratio allows South Korean nurses to focus on more technical tasks that give less stress and have higher job satisfaction because of it. However, this also leads to the South Korean nurses having less confidence in their patient's ability to take care of themselves upon discharge. South Korean nurses should also be given opportunity to advance themselves professionally and be recognized for their abilities while being given more responsibility for the clinical decision making in their patient's care.

Characteristics of internationally educated nurses in the United States.

Among an estimated 2.7 million U.S. nurse workforce in March 2000, about 4% were internationally educated nurses. This secondary analysis of the 2000 National Sample Survey of Registered Nurses profiles this unique segment of the U.S. nurse workforce. Findings indicate that internationally educated nurses have distinctive demographical, educational, and employment characteristics when compared to U.S.-trained nurses. Implications of the findings are elaborated in lieu of the present U.S. nurse shortage.

Multinomial logistic regression.

BACKGROUND: When the dependent variable consists of several categories that are not ordinal (i.e., they have no natural ordering), the ordinary least square estimator cannot be used. Instead, a maximum likelihood estimator like multinomial logit or probit should be used. OBJECTIVES: The purpose of this article is to understand the multinomial logit model (MLM) that uses maximum likelihood estimator and its application in nursing research. METHOD: The research on "Racial differences in use of long-term care received by the elderly" (Kwak, 2001) is used to illustrate the multinomial logit model approach. This method assumes that the data satisfy a critical assumption called the "independence of irrelevant alternatives." A diagnostic developed by Hausman is used to test the independence of irrelevant alternatives assumption. Models in which the dependent variable consists of several unordered categories can be estimated with the multinomial logit model, and these models can be easily interpreted. CONCLUSIONS: This method can handle situations with several categories. There is no need to limit the analysis to pairs of categories, or to collapse the categories into two mutually exclusive groups so that the (more familiar) logit model can be used. Indeed, any strategy that eliminates observations or combines categories only leads to less efficient estimates.