Effects of Life Skill Training on the School Violence Attitudes and Behavior Among Elementary School Children.

This study evaluated a life skill training program on school violence given to elementary school children. A quasi-experimental study was conducted, and a 12-week intervention was implemented targeting 70 students aged between 10 and 11 years. The instruments included peer competency, attitudes toward school violence, experience of school violence, and the Self-Control Rating Scale. The data were analyzed using repeated measure analysis of variance. A significant difference was observed between the groups over time on peer competency (F = 4.17, p = .020), attitudes toward school violence (F = 6.02, p = .004), and violence experience as a victim (F = 3.49, p = .036) and as a perpetrator (F = 3.87, p = .026). In the experimental group, the mean scores for peer competency increased compared to the control group, whereas school violence experience decreased at the posttests. A 12-week program of life skill training offered to children was effective in promoting peer competency and attitudes toward school violence, while decreasing the experience of school violence.

Effects of a cognitive rehabilitation programme on cognitive function, self-management and quality of life in patients with chronic obstructive pulmonary disease.

AIM: The study purpose was to investigate effects of a cognitive rehabilitation programme on cognitive function, self-management and quality of life in patients with chronic obstructive pulmonary disease. BACKGROUND: Cognitive impairment is frequently observed in chronic obstructive pulmonary disease patients, and it interferes with many aspects of self-management, which is fundamental to disease management and quality of life. DESIGN: The design is quasi-experimental. METHODS: Data collection was performed between June 2018 and March 2019. Study participants were 60 in- or out-patients with chronic obstructive pulmonary disease. The cognitive rehabilitation programme involved six 30-min sessions administered over a period of 2 weeks and consisted of six areas: attention, memory, language, visuospatial perception, executive function and problem solving. Cognitive function, self-management and quality of life were measured at three times (preintervention and immediately and 4 weeks after intervention). RESULTS: Cognitive function, self-management and quality of life were found to be significantly improved over time after administration of the cognitive rehabilitation programme. However, no significant improvement was observed in the control group. CONCLUSIONS: Our findings support the potential usefulness of cognitive intervention to promote cognitive function, self-management ability and quality of life in patients with chronic obstructive pulmonary disease.

Development and Clinical Validity of a Mild Vascular Cognitive Impairment Assessment Tool for Korean Stroke Patients.

PURPOSE: The present study was conducted to develop a mild vascular cognitive impairment (MVCI) assessment tool for patients with stroke and to examine its validity, reliability, and clinical adequacy. METHODS: Items of this tool were developed based on previously verified cognitive assessment tools. Face, content, and criterion (concurrent) validities, optimal cut-off score for differentiation of MVCI and normal cognitive function, clinical adequacy, internal consistency, and inter-rater reliability of the assessment tool were determined in 60 stroke patients at a university hospital located in Incheon, South Korea. RESULTS: The devised MVCI assessment tool contains 20 items which were designed to assess seven cognitive domains: orientation, memory, language, attention, reasoning/abstraction, visuospatial perception, and executive function/problem solving. Content, face, and construct validities were well supported. Clinical adequacy testing revealed that the overall probability of correctly discriminating MVCI using the MVCI assessment tool for stroke was 90.0%, which was statistically significant. Furthermore, a score of 23 was found to be the optimal cut-off score for MVCI. Internal consistency and inter-rater reliability were also well supported. CONCLUSIONS: The findings of this study indicate that the developed MVCI assessment tool for stroke could serve as a clinically useful tool for detecting MVCI and for properly assessing degree of cognitive impairment in stroke patients.

An integrative model of workplace self-protective behavior for Korean nurses.

PURPOSE: This study was conducted to develop and test a hypothetical stage model of workplace self-protective behaviors with respect to blood transmitted infections and musculoskeletal injuries for Korean nurses. METHODS: A nonexperimental, cross-sectional study design was adopted. The study participants were 320 nurses at two Korean university hospitals. Perceived sensitivity, severity, barriers, benefits, self-efficacy, social support, and safety climate were assessed. RESULTS: Overall, fit indicators showed a good fit for the hypothetical model of self-protective behaviors against blood transmitted infections and musculoskeletal injuries. The significant factors of self-protective behaviors against blood transmitted infections were perceived barriers and social support. The significant factors of self-protective behaviors against musculoskeletal injuries were perceived benefits, barriers, and self-efficacy. CONCLUSION: Our findings suggest that the significant psychosocial constructs of stages of self-protective behavior are dependent on health problem type. Accordingly, we advise that characteristics of behavior and types of disease and health problem should be given priority when developing intervention programs for particular self-protective health behaviors.

Knowledge, health-promoting behaviors, and biological risks of recurrent stroke among stroke patients in Korea.

AIM: The study was undertaken to explore stroke knowledge, health-promoting behaviors, and predictors for biological risk profiles of stroke recurrence among stroke patients in Korea. METHODS: This study was a cross-sectional descriptive study. Seventy-five stroke patients were recruited from a university medical center. Stroke knowledge, physical functioning, health-promoting life profile (HPLP), and five biological risk factors for stroke recurrence (i.e. systolic and diastolic blood pressure, total cholesterol, blood glucose, and body mass index) were measured. RESULTS: The results indicated that 70.0% of the patients selected correct answers in most of the knowledge questions. The mean score for HPLP was 3.08 ± 0.45 (range, 1-4). Twenty-seven percent of patients had their five biological risk factors under control. Education level of 9 years or less and duration of stroke diagnosis within a year were predictors for biological risk profiles of stroke recurrence (F=6.94, P<0.01). CONCLUSION: Stroke patients exhibited appropriate stroke knowledge and performed moderate to high levels of health-promoting behaviors. However, 73.2% of patients had uncontrolled risk factor(s) in one or more of the five biological risk factors for stroke recurrence. Nurses should be aware that stroke patients seeking treatments from clinics and hospitals are still at risk of stroke recurrence.

[Effects of gout web based self-management program on knowledge related to disease, medication adherence, and self-management].

PURPOSE: This study was conducted to examine the changing patterns of knowledge related to disease, medication adherence, and self-management and to determine if outcomes were more favorable in the experimental group than in the comparison group through 6 months after providing a web-based self-management intervention. METHODS: A non-equivalent control group quasi-experimental design was used and 65 patients with gout, 34 in experimental group and 31 in comparison group, were selected from the rheumatic clinics of two university hospitals. Data were collected four times, at baseline, at 1 month, 3 months, and 6 months after the intervention. RESULTS: According to the study results, the changing patterns of knowledge and self-management were more positive in the experimental group than in the control group, whereas difference in the changing pattern of medication adherence between two groups was not significant. CONCLUSION: The results indicate that the web-based self-management program has significant effect on improving knowledge and self-management for middle aged male patients with gout. However, in order to enhance medication adherence, the web-based intervention might not be sufficient and other strategies need to be added.

Development of a Decision Tree Analysis model that predicts recovery from acute brain injury.

AIM: The present study was conducted to identify significant demographic, illness-related, and physiological factors associated with recovery at 1 month after brain injury, and to develop and evaluate a Decision Tree Analysis-based prediction model. METHODS: This study was conducted using a prospective study design. The study subjects were 190 adult patients with brain injury admitted to the neurological intensive care unit of a university hospital located in Incheon, South Korea. Degree of recovery from brain injury was evaluated 1 month after admission using the Glasgow Outcome Scale. RESULTS: A prediction model was developed using Decision Tree Analysis. The most significant predictor of recovery at 1 month after brain injury using the devised model was Glasgow Coma Scale score on admission, and its optimum cut-off value for the differentiation of good and poor recovery was 8.5. The next best predictors were age and blood glucose level on admission, which had cut-off values of 49.5 years and 155 mg/dL, respectively. In addition, hematoma volume, systolic blood pressure, and respiratory rate on admission were also found to predict 1 month recovery significantly, with corresponding cut-off values of 44 cc, 168 mmHg, and 29/min, respectively. CONCLUSION: The developed model includes common and routinely used monitoring parameters as significant predictors, and proposes cut-off values for these predictors. This model appears to be useful for predicting 1 month recovery in various brain injury types. The authors believe that the devised model provides a basis for the evidence-based nursing care of brain injured patients during the acute stage.

Psychosocial influencers and mediators of treatment adherence in haemodialysis patients.

AIM: This article is a report of the development and testing of the hypothetical model that illustrates relationships between treatment adherence and its psychosocial influencing factors and to elucidate the direct and indirect (mediating) effects of factors on treatment adherence. BACKGROUND: Poor adherence has been consistently reported in haemodialysis patients. Much research has showed various influencing factors of adherence, but these studies have failed to identify consistent influencing factors. DESIGN: This study was performed using a non-experimental, cross-sectional design. METHODS: The study subjects were 150 end-stage renal failure patients on haemodialysis at a university hospital located in Incheon, South Korea. Data were collected over 10 months (June 2010-April 2011). FINDINGS: The hypothetical model provided a good fit with data. Haemodialysis-related knowledge, perceived barrier to adherence, self-efficacy on adherence, and healthcare provider support had significant effects on adherence. Self-efficacy was found to mediate barrier-adherence and family support-adherence relationships. Self-efficacy in combination with barrier, family support, and healthcare provider support was found to mediate the depression-adherence relationship. CONCLUSION: Strategies aimed at the development of successful adherence interventions should focus on reducing perceived barriers and enhancing self-efficacy and knowledge. It can be suggested that efforts to improve the healthcare provider-patient relationship would enhance adherence. In depressive patients, strategies that promote self-efficacy and the support of family or healthcare providers could diminish the negative impact of depression on adherence.

Non-infectious hyperthermia in acute brain injury patients: relationships to mortality, blood pressure, intracranial pressure and cerebral perfusion pressure.

The present study was conducted to investigate the frequency of hyperthermia during the first 72 h after acute brain injury, and to compare subjects that developed hyperthermia with those that did not with respect to blood pressure, intracranial pressure (ICP), cerebral perfusion pressure (CPP), Glasgow Coma Scale (GCS) score and mortality. This study was conducted by performing a retrospective medical record review of 126 brain injury patients admitted to the neurological intensive care unit of a university hospital located in Incheon, South Korea. Our results showed that 25.4% of the subjects had hyperthermia for at least 1 day during the first 3 days of hospitalization. Hyperthermic subjects demonstrated higher mortality and ICP, and lower CPP and GCS scores than non-hyperthermic subjects, indicating a reduced cerebral blood flow. The findings may provide a possible explanation for poor clinical outcome and offer justification for the careful monitoring of body temperature in patients with acute brain injury.

Systematic review and meta-analysis of the correlates of cancer-related fatigue.

BACKGROUND: Fatigue is one of the most common problems experienced by cancer patients. The factors most frequently reported to correlate with cancer-related fatigue are symptom distress (pain, nausea/vomiting, dyspnea, and lack of appetite) and psychological distress (depression and anxiety). AIMS: This study was performed to examine the overall association of symptom and psychological distress with cancer-related fatigue using systematic literature review and meta-analysis. This study also aimed to determine which factors have a higher correlation with fatigue, and therefore should receive nursing priority. METHODS: A meta-analysis of 30 primary studies identified by searching computer databases, which included MEDLINE, PubMed, and CINAHL. RESULTS: Results showed that all symptoms (pain, dyspnea, nausea/vomiting, and lack of appetite) and psychological distress (depression and anxiety) included had a significant association with cancer-related fatigue with medium-to-large effect sizes, which were estimated using correlation coefficients. The overall correlations of psychological distress with cancer-related fatigue were found to be higher than those of symptom distress. The correlation of nausea/vomiting with cancer-related fatigue was higher than those of pain and dyspnea. CONCLUSIONS AND IMPLICATIONS: Our findings highlight the importance of psychological distress in dealing with cancer-related fatigue in addition to the need to be attentive to a patient's symptom distress. Of the symptom distress, nausea/vomiting should be prioritized by nurses when managing cancer-related fatigue. This study provides sound empirical evidence that can be used to draft guidelines for the management of cancer-related fatigue.

Polymorphisms of 5,10-methylenetetrahydrofolate reductase and thymidylate synthase in squamous cell carcinoma and basal cell carcinoma of the skin.

Genetic instability resulting from mutations in repair genes, defects in folic acid metabolism or DNA synthesis has been reported to contribute significantly to the development of skin cancer. The enzymes 5,10-methylenetetrahydrofolate reductase (MTHFR) and thymidylate synthase (TS) are essential participants in folic acid metabolism and DNA synthesis. Thus, the present case-control study was conducted to determine whether an association exists between the MTHFR/TS polymorphisms and squamous cell carcinoma (SCC) and/or basal cell carcinoma (BCC) among Korean individuals. The study subjects comprised 95 patients with SCC, 100 patients with BCC and 207 controls with no evidence of malignancy or pre-malignant lesions. Patients with skin cancer and control samples were analyzed for polymorphisms of the MTHFR or TS genes by means of polymerase chain reaction-restriction fragment length polymorphism. The MTHFR 677C>T and MTHFR 1298A>C polymorphisms showed no significance with regard to the development of SCC and BCC. However, within the 6 bp insertion (ins)/deletion (del) polymorphism in the 3'-untranslated region (3'-UTR) of the TS gene, the BCC group showed statistical significance with a 2.8-fold increased risk of cancer development [adjusted odds ratio (AOR)=2.821] in heterozygous mutations (0 bp/6 bp), 7.5-fold (AOR=7.539) in homozygous mutations (6 bp/6 bp) and 3-fold (AOR=3.079) upon combination of heterozygous mutations and homozygous mutations (0 bp/6 bp + 6 bp/6 bp). We thus conclude that the 6 bp ins/del polymorphism in the 3'-UTR is associated with increased risk of the development of skin cancer among Korean individuals with BCC.

[Influence of age, gender, and severity on recovery of patients with brain injury].

PURPOSE: This study was conducted to investigate the individual and cross influences of age, gender, and severity on recovery of patients with brain injury. METHODS: For the purpose of the study, traumatic or spontaneous brain injury patients admitted to the intensive care unit (ICU) were conveniently selected. The data regarding outcomes were collected 3 months after admission. RESULTS: Individual influences of the study variables on patients' recovery were significant, except for gender. But while the individual influence of gender on recovery was not significant, cross influence of gender and age was significant, but only for the sub-dimension of 'arousalbility and awareness'. The study results also showed that 3-way cross influence of gender, age, and severity was only significant on the sub-dimension of 'arousalbility and awareness'. CONCLUSION: The sub-dimension of recovery cross influenced by the demographic factors of gender and age, and severity was 'arousalbility and awareness'. This might indicate that the study variables that cross influencing recovery had more influence on consciousness compared to physical function and psycho-social adaptation.

Comparisons of the prognostic predictors of traumatic brain injury according to admission Glasgow Coma Scale scores-based on 1- and 6-month assessments.

PURPOSE: The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. METHODS: The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. RESULTS: The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. CONCLUSIONS: The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation Methods. This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.

[Comprehensive predictors of fatigue for cancer patients].

PURPOSE: This study was conducted to identify comprehensive predictors of fatigue in cancer patients. METHODS: One hundred ten cancer patients visiting in-patient or out-patient clinics of a university hospital located in Incheon participated in this study. RESULTS: The hematologic indicators (WBC and Hemoglobin) were significant for explaining fatigue. The psychological factors of fatigue were statistically significant. Both anxiety and depression, included as psychological factors, were significant in explaining fatigue in cancer patients. The influence of physical factors on fatigue was also statistically significant. Among the variables included as physical factors, pain, nausea/vomiting/anorexia, and sleep disturbance were significant whereas, dyspnea was not significant. The influence of the daily activity factor on fatigue was statistically significant. Among the variables included as daily activity factors, regular exercise or not and the usual activity level were significant in explaining fatigue of cancer patients, while the level of rest was not statistically significant. CONCLUSIONS: From the study results fatigue of cancer patients appeared to be influenced by multidimensional factors, such as physiological, physical, psychological, and activity related factors.

[Factors affecting the severity of urinary incontinence and the quality of life of women with urinary incontinence].

PURPOSE: This study was conducted to investigate the factors that affect the severity of urinary incontinence and the quality of life of women with urinary incontinence. METHODS: An exploratory correlation research design was applied and the sixty women who responded that they currently experience involuntary urine leakage at least once per week were invited to participate in the study. RESULTS: According to the study results, the factors that significantly contribute to the severity of urinary incontinence were age, number of parity, and number of normal deliveries. Other influencing factors, such as obesity, menopausal state, hysterectomy, and number of episiotomies, were not significant to predict the severity of urinary incontinence. Urinary incontinence frequency per week and duration of experiencing urinary incontinence were shown to be factors that significantly affect quality of life. CONCLUSION: In women above 60 years old, multiparity, and multiple experiences of vaginal delivery tended to present a higher level of severity of urinary incontinence. In addition, women with higher frequencies of urinary incontinence per week and a longer duration of urinary incontinence showed a lower level of quality of life.

[Development of an integrative cognitive rehabilitation program for brain injured patients in the post-acute stage].

PURPOSE: This study was conducted to develop a comprehensive cognitive rehabilitation program that can be easily applied to brain injured patients by family members or nurses in community or hospital settings. METHODS: A Systemic literature review design was used. Thirty-three related studies were reviewed. RESULT: Based on the results of the literature review, the training tasks for attention were designated to enhancing 4 hierarchical areas, i.e., focused, selective, alternating, and divided attention. On the other hand, the memory rehabilitation tasks mainly consisted of mnemonic skills, such as the association method which helps patients memorize given information by linking together common attributes, the visual imagery method, and self-instruction method. The problem solving rehabilitation program included a task of games or plays which stimulated the patients' curiosity and interest. The training tasks for problem solving were to encourage the process of deriving reasonable solutions for a problematic situation resembling real problems that the patients were faced with in their everyday life. CONCLUSION: It is expected that the cognitive rehabilitation program developed from this study could help patients having difficulty in their every day life, due to a reduced cognitive ability resulting from brain injury, to effectively adapt to every day life.

Effectiveness of a behavioral intervention program for urinary incontinence in a community setting.

PURPOSE: The purposes of this study were to examine the effectiveness of a behavioral intervention program combining pelvic floor muscle exercise with bladder training for urinary incontinence and also to conduct follow-up assessment after self-training. METHODS: This study was conducted using a non-equivalent control group, pretest-posttest design. The subjects were 60 middle-aged women (control group, n=30; intervention group, n=30) who experienced an episode of urinary incontinence at least once a week. The program was run over a 4 week period (once a week) and composed of urinary incontinence education, pelvic floor muscle exercise, and bladder training. RESULTS: Overall, there was a significant difference in urinary incontinence symptoms and psycho-social wellbeing related to urinary incontinence between the treatment and control group. Of the variables, weekly leakage frequencies, leakage amounts on each occasion, leakage index, frequencies of nocturia, and quality of life were significantly different between the groups. Follow-up assessment (9th week) indicated that overall incontinence symptoms and psycho-social well-being were significantly different between the posttest and follow-up assessments. Most variables of incontinence symptoms and psycho-social well-being were significantly improved at follow-up assessment versus posttest. CONCLUSIONS: The program was overall effective in terms of relieving symptoms and improving psycho-social well-being related to urinary incontinence, and this effect continued after a 4-weeks self-training period. In the respect that this is a community-based application study, the results can be meaningful and applicable.

[Meta-analysis on the effectiveness of pulmonary rehabilitation program on exercise capacity/tolerance and general health status].

PURPOSE: This study was conducted to combine the effects of pulmonary rehabilitation program (PRP) on exercise capacity/tolerance and general health status of COPD patients based on the primary research results examined the effects of PRP. METHOD: Seventeen studies were selected by the sampling criteria established to include the studies that reported enough statistics necessary to conduct meta-analysis. RESULT: According to the study results, the most effective indicators for exercise capacity/tolerance were exercise time (such as cycling time or treadmill walking time) and ground walking distance within given time (6 minutes or 12 minutes), whereas effects on such indicators as VE and VO2 were not statistically significant. PRP induced significant effect on patients' general health status, frequently measured by physical, psycho-emotional, and holistic indicators, the enhancement on psycho-emotional dimension resulted from PRP was more prominent than those of the other dimensions. From the results, it was noted that the place where PRP was given and the contents of PRP exercised their influence on the outcome variables. Which body part was trained was also one of the important factors that influence on the patients' perception of dyspnea during exercise as well as on exercise capacity/tolerance. CONCLUSION: PRP including exercise training significantly improved the exercise capacity and general health status of COPD patients.

[Meta-analysis on the effectiveness of interventions applied to preventing endotracheal suction-induced hypoxemia].

PURPOSE: This study was conducted to investigate the effects of the suction-induced hypoxemia interventions. METHOD: 30 suction-induced hypoxemia interventions were reviewed for the purpose of meta-analysis. RESULT: The study showed that both preoxygenation and insufflation were the most frequently examined oxygenation time periods, and hyperoxygenation combined with hyperinflation was the most commonly applied oxygenation method in order to prevent suction-induced hypoxemia. The greatest effect was obtained by providing oxygenation before and after suctioning, whereas negative effect(the contrary results from the study hypotheses) was frequently obtained by applying insufflation only. Applying hyperoxygenation combined with hyperinflation had the greatest effect over that of applying hyperoxygenation only, even though the difference between effect sizes of both methods were statistically significant. CONCLUSION: The results of meta-analysis showed that the occurrence rate of hypoxemia after suctioning was significantly reduced with the overall interventions for hypoxemia (decreasing 40% of occurrence rate), independent with time periods or methods for providing oxygenation.

The circadian rhythms of blood pressure and heart rate in the hypertensive subjects: dippers and non-dippers.

The purpose of this study was to compare the circadian blood pressure and heart rate rhythm of dippers and non- dippers. Biochemical and clinical characteristics of dippers and non-dippers were also compared to determine whether non-dippers have an increased prevalence of hypertension- related conditions. The subjects were 123 out-patients with essential hypertension who had undergone ambulatory blood pressure monitoring at the University Hospital in Inchon, South Korea, from January 1, 1997 to December 31, 1998. Daytime values were determined between 6:00 AM and 8:00 PM and the nighttime values were determined between 8:00 PM and 6:00 AM. Non-dippers were defined as those who showed a reduction in systolic blood pressure, diastolic blood pressure or heart rate less than 10% and they accounted for 25%, 32% and 31% of the subjects, respectively. The timings of the circadian systolic and diastolic blood pressure and heart rate in dippers were very consistent: showing the lowest values during the night, rising in the early morning and reaching a plateau in the late morning. Non-dippers' circadian rhythms of systolic and diastolic blood pressures fluctuated less than those of dippers, and the 24-hours heart rate rhythms of the dipper and non- dipper groups were completely reversed. None of the biochemical characteristics tested in the present study showed a significant difference between dippers and non-dippers whether dipper was classified by systolic or diastolic blood pressure or heart rate. Similarly, hypertension-related symptoms and complications were not associated with the dipper/non-dipper description, whether classified by sBP, dBP, or HR.