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IntroductionStealth use implies using tobacco products where their use is prohibited. This paper aimed to investigate stealth use of heated tobacco products (HTPs) in terms of its prevalence and associated factors.MethodsAn online survey was conducted to investigate the use of HTPs in 7000 randomly selected participants (2300 men and 4700 women, aged 20–69 years) from the database registered with an online-research company; we used a sex ratio of 1:2, considering a low female prevalence of tobacco use in Korea. Of total participants, 574 (8.2%) were current HTP users. Among them, we identified the participants who had practised HTPs stealth use, and evaluated associated factors using multivariable Poisson regression.ResultsA total of 574 participants were identified as current HTP users, and 455 (79.2%) reported stealth use of HTPs during the month before the survey. Stealth use was more frequent in dual cigarette users (HTPs and electronic cigarettes (ECs); adjusted prevalence ratio (aPR) 1.33, 95% CI 1.16 to 1.52) and triple users (HTPs, ECs and combustible cigarettes; aPR 1.18, 95% CI 1.04 to 1.33), as compared with single-HTP users. Stealth use was more prevalent among participants who agreed with allowing indoor HTP use (aPR 1.18, 95% CI 1.11 to 1.26).ConclusionStealth use was prevalent among current HTP users, especially among the poly-users of tobacco products. Considering the positive relationship between an agreement with allowing indoor use of HTPs and stealth use, a campaign to promote change in attitudes of HTP users about their indoor use may be warranted to protect non-users.

Background Few investigators have explored challenges and facilitators to exergaming, essential factors to exergaming adherence, among patients with heart failure. Objectives In this qualitative study, we explored facilitators and challenges using a home-based exergame platform, the Nintendo Wii Sports, in patients with heart failure. Methods Semistructured face-to-face interviews were conducted in 13 participants given a diagnosis of heart failure (age range, 34-69 years). Participants were asked about their experiences with exergaming. Transcribed interviews were analyzed with content analysis. Results The following 4 facilitators were identified: (1) enjoyment and competition motivated gaming, (2) accessibility at home gave freedom and lowered participants' barriers to exercise, (3) physical benefits when decreasing sedentary lifestyle, and (4) psychosocial benefits on stress, mood, and family interactions. Challenges included (1) diminished engagement over time due to boredom playing similar games and (2) frustrations due to game difficulty and lack of improvement. Conclusion Exergaming can increase individuals' physical activity because of easy accessibility and the fun and motivating factors the games offer. Participants initially found exergaming enjoyable and challenging. However, engagement diminished over time because of boredom from playing the same games for a period of time. Participants' preferences and capacities, participants' past experiences, and social support must be considered to avoid boredom and frustrations. Future studies are warranted to determine adherence to exergaming among patients with heart failure and, ultimately, increased overall well-being and healthcare delivery in this patient population.

This study investigates how serendipitous suggestions enhance user engagement with and sociality perceptions of movie recommendation system (RS). We constructed a mock-up recommendation system that...

Objective To systematically translate the Fugl-Meyer Assessment (FMA) into a Korean version of the FMA (K-FMA).Methods We translated the original FMA into the Korean version with three translators and a translation committee, which included physiatrists, physical therapists, and occupational therapists. Based on a test-retest method, each of 31 patients with stroke was assessed by two evaluators twice, once on recruitment, and again after a week. Analysis of intra- and inter-rater reliabilities was performed using the intra-class correlation coefficient, whereas validity was analysed using Pearson correlation test along with the Motricity Index (MI), Motor Assessment Scale (MAS), and Berg Balance Scale (BBS).Results The intra- and inter-rater reliabilities were significant for the total score, and good to excellent reliability was noted in all domains except for the joint range of motion of the lower extremity domain of the K-FMA. The MI and MAS scores were significantly correlated with all domains, all with p

Background: Healthcare disparities continue to exist among the Vietnamese American (VA) community and many factors (e.g., fear of social stigma) deter family caregivers of persons with dementia (PWD) from seeking assistance. Purpose: To pilot-test a language-specific and culturally appropriate mindfulness intervention to improve dementia VA family caregiver well-being. Methods: Bilingual, trained research assistants administered a mindfulness exercise (i.e., deep breathing) to family caregivers and provided continuous support and care resources through weekly home visits for a month. Weekly surveys measured changes in emotion, feelings of connectedness to the PWD, and mood (i.e., happiness) before and after the intervention. Results: A total of nine VA family caregivers of PWD participated in this pilot study. Positive affect showed an increasing trend (Mpre = 16.0 (SD = 3.48), Mpost = 17.1 (SD = 3.06)) and negative affect showed a decreasing trend (Mpre = 6.44 (SD = 3.31), Mpost = 5.22 (SD = 0.359)). Happiness showed an increasing trend (Mpre = 4.30 (SD = 0.767), Mpost = 4.44 (SD = 0.873)). Conclusions: These findings suggest that a home-based dementia family caregiver intervention with mindfulness exercises may potentially increase positive affect and decrease negative affect in Vietnamese American family caregivers of PWD. Similar interventions may help reduce caregiver burden in dementia family caregivers of other cultures.

Objective To compare the energy efficiency of gait with knee-ankle-foot orthosis (KAFO) and robot-assisted gait and to develop a usability questionnaire to evaluate the satisfaction of walking devices in paraplegic patients with spinal cord injuries.Methods Thirteen patients with complete paraplegia participated and 10 completed the evaluation. They were trained to walk with KAFO (KAFO-gait) or a ReWalk robot (ReWalk-gait) for 4 weeks (20 sessions). After a 2-week wash-out period, they switched walking devices and underwent 4 additional weeks of training. Two evaluations were performed (after 2 and 4 weeks) following the training periods for each walking device, using the 6-minute walking test (6MWT) and 30-minute walking test (30MWT). The spatiotemporal variables (walking distance, velocity, and cadence) and energy expenditure (heart rate, maximal heart rate, the physiologic cost index, oxygen consumption, metabolic equivalents, and energy efficiency) were evaluated duringthe 6MWT and 30MWT. A usability evaluation questionnaire for walking devices was developed based on the International Organization for Standardization/International Electrotechnical Commission guidelines through expert consultation.Results The ReWalk-gait presented significant advantages in energy efficiency compared to KAFO-gait in the 6MWT and 30MWT; however, there were no differences in walking distance or speed in the 30MWT between ReWalk-gait and KAFOgait. The usability test demonstrated that ReWalk-gait was not superior to KAFO-gait in terms of safety, efficacy, efficiency, or patient satisfaction.Conclusion The robot (ReWalk) enabled patients with paraplegia to walk with lower energy consumption compared to KAFO, but the ReWalk-gait was not superior to KAFO-gaitin terms of patient satisfaction.

In-game advertising (IGA) is a unique opportunity for advertisers to creatively interact with engaged consumers. As there continues to be tremendous growth in the gaming industry, research ...

Purpose The aim of the study was to develop and validate machine learning models to predict the personalized risk for 30-day readmission with venous thromboembolism (VTE). Design This study was a retrospective, observational study. Methods We extracted and preprocessed the structured electronic health records (EHRs) from a single academic hospital. Then we developed and evaluated three prediction models using logistic regression, the balanced random forest model, and the multilayer perceptron. Results The study sample included 158,804 total admissions; VTE-positive cases accounted for 2,080 admissions from among 1,695 patients (1.31%). Based on the evaluation results, the balanced random forest model outperformed the other two risk prediction models. Conclusions This study delivered a high-performing, validated risk prediction tool using machine learning and EHRs to identify patients at high risk for VTE after discharge. Clinical relevance The risk prediction model developed in this study can potentially guide treatment decisions for discharged patients for better patient outcomes.

BACKGROUND A high level of apolipoprotein B (apoB) is associated with incident coronary artery disease (CAD) when low-density lipoprotein cholesterol (LDL-C) level is discordantly low or concordantly high. However, data on the relationship of apoB with subclinical measure of CAD are limited.Methods and Results:A total of 14,205 men (mean age 41.0 years) who were free of cardiovascular disease at baseline and who underwent a health checkup exam, including measurement of coronary artery calcium (CAC), were studied. Of the study group, 2,773 participants (19.5%) had CAC at baseline, and CAC progression was observed in 2,550 (18.0%). The multivariate-adjusted CAC score ratios (95% confidence interval) comparing discordantly high apoB/low LDL-C and concordantly high apoB/high LDL-C with concordantly low apoB/low LDL-C were 1.51 (0.98-2.32) and 2.70 (2.19-3.33), respectively. The corresponding relative risks for CAC progression were 1.26 (1.02-1.56) and 1.49 (1.34-1.66), respectively. These associations did not change appreciably after adjustment for insulin resistance and subclinical inflammation. CONCLUSIONS Discordant analysis showed that a high apoB level was strongly associated with prevalence and progression of CAC independent of LDL-C in a large cohort of healthy adults. The present study results highlighted the importance of an apoB measure as a potential target for primary prevention of coronary atherosclerosis in healthy adults.

Family members provide the majority of caregiving to individuals living with Alzheimer’s disease (AD) and related dementias. Asian American families are disproportionately impacted by the burden of caregiving due to limited knowledge about the disease in this community. This study explored how Vietnamese American caregivers understand AD and provide care to family members with AD. Twenty caregivers who have provided care to a family member with AD participated in a semi-structured qualitative interview. Data were analyzed using thematic analysis. Several themes were identified in the caregivers’ understanding of AD: (a) “Now I know:” the disruptions, shocks and surprises leading up to the initial diagnosis; (b) The frustrations of managing family members’ cognitive impairments; (c) “Going with the flow:” challenges in managing personality and behavioral changes; (d) The exhaustion of around-the-clock caregiving; (e) “Taking it day by day” in the face of progressively worsening symptoms. Underlining the participants’ descriptions of AD was a shared understanding of the progressively worsening, complex and unpredictable nature of the disease that makes it challenging for family caregivers on a daily basis. Findings provide important implications for healthcare workers’ outreach to Vietnamese American families to ease the caregiving experience through culturally-responsive education, thereby enhancing the families’ ability to recognize the early symptoms and seek appropriate help.

Alloyed semiconductor nanowires (NWs) are of great interest for next-generation integrated optoelectronic nanodevices owing to their tunable band gap and emission wavelength. In this study, we synthesized the GaAsSe ternary alloy nanowires (NWs) with various compositions between GaAs and Ga2Se3 using chemical vapor transport method. The band gap was continuously tuned in the range of 1.5–2.1 eV because of the completely miscible solid solution at all compositions. The alloy NWs (including Ga2Se3) consisted of a cubic phase with the [011] growth direction, in contrast with the GaAs NWs grown along the [111] direction. In particular, the GaAs1–xSex (x = 0.3) alloy NWs were grown from Ga-rich Au nanoparticles such as cubic-phase AuGa2 and had a defect-free single-crystalline nature. X-ray photoelectron spectroscopy analysis reveals much less surface oxide layers for x = 0.3, suggesting that Se incorporation at this composition effectively diminishes the surface defects. We fabricated photodetectors using the...

PURPOSE The study aimed to examine how registered nurses (RNs) and paraprofessional home visitors (PHVs) work together as a team to care for underserved perinatal women in a coordinated home visitation program. DESIGN AND METHODS Qualitative methods were used to understand the perspectives of three RNs and twenty PHVs who worked at MOMS Orange County, a community-based perinatal health program. Individual one-on-one interviews were administered with the RNs and focus groups with the PHVs. Qualitative content analysis was conducted to synthesize themes. RESULTS RNs perceived themselves as educators, mentors, and supervisors. PHVs thought of themselves as supporters, coaches, and advocates. Interdependence and proactive communication were favorable characteristics of the relationship in which RNs trained PHVs to provide health education. The positive interactions between RNs and PHVs appeared to enhance the client-healthcare provider connection. CONCLUSIONS Our study is one of the first to describe relationships and communication patterns among the healthcare team in a coordinated home visitation program in the United States. Future studies should examine how additional members of the team, including clients and healthcare providers, view their experiences with a home visitation program.

Background According to the Juvenile Protection Act in Korea, no one is allowed to sell, rent, or distribute tobacco products to adolescents. Furthermore, the Framework Convention on Tobacco Control Article 16 prohibits the sale of tobacco products to minors. In this study, we investigated the trends in and associated factors of the ease of cigarette purchase among Korean adolescents from 2005 to 2016. Methods The analyses were based on the data of the Korea Youth Risk Behavior Web-based Survey. We estimated the trends in the ease of cigarette purchase from 2005 to 2016 and evaluated associated factors. Ease of cigarette purchase was defined as the proportion of adolescents who were able to purchase cigarettes from among those who had tried to purchase cigarettes in the past 30 days. Results The ease of cigarette purchase began decreasing since 2008 (81.3%) compared to 2005 (83.9%). It decreased to 76.5% in 2013 and further decreased to 71.4% in 2016. The ease of cigarette purchase increased for adolescents who were in higher grades, smoked larger amounts of cigarettes per day, lived in metropolitan cities, had problematic drinking in the past year, and had close friends who smoked. It decreased in adolescents who had current smokers among their family members. Conclusions Although the proportion of adolescents who were able to purchase cigarettes significantly decreased starting in 2008, more than 70% of Korean adolescents can still purchase cigarettes. Enforcement of the Juvenile Protection Act must be strengthened in order to prevent cigarette use among adolescents. Electronic supplementary material The online version of this article (10.1186/s12889-018-6151-9) contains supplementary material, which is available to authorized users.

Strain engineering of nanowires (NWs) has been recognized as a powerful strategy for tuning the optical and electronic properties of nanoscale semiconductors. Therefore, the characterization of the strains with nanometer-scale spatial resolution is of great importance for various promising applications. In the present work, we synthesized single-crystalline zinc blende phase GaP and GaAs NWs using the chemical vapor transport method and visualized their bending strains (up to 3%) with high precision using the nanobeam electron diffraction technique. The strain mapping at all crystallographic axes revealed that (i) maximum strain exists along the growth direction ([111]) with the tensile and compressive strains at the outer and inner parts, respectively; (ii) the opposite strains appeared along the perpendicular direction ([2̅11]); and (iii) the tensile strain was larger than the coexisting compressive strain at all axes. The Raman spectrum collected for individual bent NWs showed the peak broadening and red shift of the transverse optical modes that were well-correlated with the strain maps. These results are consistent with the larger mechanical modulus of GaP than that of GaAs. Our work provides new insight into the bending strain of III–V semiconductors, which is of paramount importance in the performance of flexible or bendable electronics.

Background Mobile health (mHealth) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases. However, the evidence of its effectiveness in chronic disease management in the adult population is still lacking. We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in randomized controlled trials (RCTs) to improve chronic disease management. Methods Relevant randomized controlled studies that were published between January 2005 and March 2016 were searched in six databases: PubMed, CINAHL, EMBASE, the Cochrane Library, PsycINFO, and Web of Science. The inclusion criteria were RCTs that conducted an intervention using mobile devices such as smartphones or tablets for adult patients with chronic diseases to examine disease management or health promotion. Results Of the 12 RCTs reviewed, 10 of the mHealth interventions demonstrated statistically significant improvement in some health outcomes. The most common features of mHealth systems used in the reviewed RCTs were real-time or regular basis symptom assessments, pre-programed reminders, or feedbacks tailored specifically to the data provided by participants via mHealth devices. Most studies developed their own mHealth systems including mobile apps. Training of mHealth systems was provided to participants in person or through paper-based instructions. None of the studies reported the relationship between health outcomes and patient engagement levels on the mHealth system. Conclusions Findings from mHealth intervention studies for chronic disease management have shown promising aspects, particularly in improving self-management and some health outcomes. Electronic supplementary material The online version of this article (10.1186/s12911-018-0591-0) contains supplementary material, which is available to authorized users.

Background: We aimed to investigate the association between alcohol drinking patterns and the presence of impaired fasting glucose (IFG) and diabetes mellitus (DM). Methods: We used data from the Korean National Health and Nutrition Examination Survey, 2010–2014. The participants were aged ≥30 years and had no previous diagnosis of DM. High-risk drinking was defined as alcohol consumption of ≥7 glasses at a sitting for men, and ≥5 glasses for women. After adjusting for confounding factors, a polychotomous logistic regression analysis was performed to assess the association of drinking patterns with IFG and DM. Results: For men, high-risk drinking was associated with higher odds ratios (ORs) of IFG (2–4/month, OR 1.51; 95% confidence interval [CI], 1.13–2.04; 2–3/week, OR 1.79; 95% CI, 1.38–2.33; and ≥4/week, OR 2.24; 95% CI, 1.65–3.03) and of DM (2–4/month, OR 2.12; 95% CI, 1.20–3.77; 2–3/week, OR 1.78; 95% CI, 1.05–3.03; and ≥4/week, OR 2.98; 95% CI, 1.72–5.17). For women, high-risk drinking was associated with higher risk of IFG (2–4/month, OR 1.51; 95% CI, 1.04–2.21; 2–3/week, OR 3.19; 95% CI, 2.20–4.64; and ≥4/week, OR 2.23; 95% CI, 1.23–4.06), but not of DM, compared with non-high-risk drinkers who consumed alcohol ≤1 day/month. Non-high-risk drinkers who consumed alcohol ≥4 days/week had higher ORs of DM in men, but lower ORs of DM in women compared with non-high risk drinkers who consumed alcohol ≤1 day/month. Conclusions: Compared with non-high-risk alcohol drinking, even occasional high-risk alcohol drinking was associated with a higher risk of IFG in men and women, and DM in men. Nearly daily non-high-risk alcohol drinking was associated with a higher risk of DM in men and lower risk of DM in women.

Two-dimensional (2D) layered structures have recently drawn worldwide attention because of their intriguing optical and electrical properties. In this study, we prepared GeAs nanosheets as a new 2D material by a liquid-phase exfoliation method. The few-layered nanosheets had a band gap close to 2.1 eV, which is significantly higher (by about 1.5 eV) compared to the bulk. The value of 2.1 eV is in excellent agreement with that for the monolayer obtained from first-principles (HSE-06) calculations; mono-, bi-, tri-, and tetra-layers have remarkable direct or quasi-direct band gaps of 2.125, 1.339, 1.112, and 1.017 eV, respectively. The electrical properties of individual GeAs nanosheets were measured to reveal their 2D carrier transport behaviors. We also observed stable and large photocurrents, indicating potential application in high-performance optoelectronic nanodevices. The few-layered GeAs nanosheets deposited on n-type Si nanowire arrays showed promising photoelectrochemical water splitting under visible light irradiation. Band alignment based on the calculated band edge positions suggested a buildup of the space charge region in the p-GeAs/n-Si heterojunction, as well as the band bending of n-Si at the electrolyte interface.

Objectives Families of ethnic minority persons with dementia often seek help at later stages of the disease. Little is known about the effectiveness of various methods in supporting ethnic minority dementia patients' caregivers. The objective of the study was to identify smartphone and computer usage among family caregivers of dementia patients (i.e., Korean and Vietnamese Americans) to develop dementia-care education programs for them. Methods Participants were asked various questions related to their computer or smartphone usage in conjunction with needs-assessment interviews. Flyers were distributed at two ethnic minority community centers in Southern California. Snowball recruitment was also utilized to reach out to the families of dementia patients dwelling in the community. Results Thirty-five family caregivers, including 20 Vietnamese and 15 Korean individuals, participated in this survey. Thirty participants (30 of 35, 85.7%) were computer users. Among those, 76.7% (23 of 30) reported daily usage and 53% (16 of 30) claimed to use social media. A majority of the participants (31 of 35, 88.6%) reported that they owned smartphones. More than half of smartphone users (18 of 29, 62%) claimed to use social media applications. Many participants claimed that they could not attend in-class education due to caregiving and/or transportation issues. Conclusions Most family caregivers of dementia patients use smartphones more often than computers, and more than half of those caregivers communicate with others through social media apps. A smartphone-app-based caregiver intervention may serve as a more effective approach compared to the conventional in-class method. Multiple modalities for the development of caregiver interventions should be considered.

Background and objectives Triple negative breast cancer (TNBC) carries a worse prognosis compared to the other subtypes. There have been conflicting studies that race may impact the prognosis of TNBC patients. We aim to determine the incidence and prognosis of TNBC among the different ethnic races in Singapore, and to determine its associated risk factors for prognosis. Methods Patients diagnosed with invasive breast cancer (BC) from 2005 to 2013 at our tertiary institution were included and divided according to race and subtypes. Demographic and clinical information of non-metastatic TNBC patients were analyzed. Log-rank test, univariate and multivariate Cox proportional hazard regression models were used to find associated risk factors related with overall survival (OS) and disease-free survival (DFS). Results Among 1227 BC patients, 129 (10.5%) had TNBC. TNBC patients had the worst OS (P: 0.0005) and DFS (P: 0.0016) among the subtypes. However, variations in race did not have any difference in OS or DFS among TNBC patients. Axillary lymph node involvement, invasive lobular histology, larger tumor size, and the presence of lymphovascular invasion (LVI) were factors associated with both poor DFS and OS among TNBC patients. Conclusions Racial variation did not have any impact on the prognosis of the TNBC.

To evaluate the risk of breast cancer in middle-aged women with metabolic syndrome using the National Health Insurance Service-National Sample Cohort (NHIS-NSC). We analyzed 23,820 women aged 50–64 years who participated in the NHIS-NCS in 2008 and 2009. We excluded subjects with any previous history of cancer or with inadequate information regarding metabolic syndrome. Participated subjects underwent anthropometric measurements and provided fasting blood samples for the assessment of glucose and lipid profiles, and answered a lifestyle questionnaire. Cox regression analysis was performed to evaluate relative risks (RRs) and 95% confidence intervals (CIs) for the association between metabolic syndrome and breast cancer. During the 5-year follow-up, 131 subjects were newly diagnosed with breast cancer (incidence, 10.86 per 10,000 person years). After adjusting for age and body mass index, the RR for incident breast cancer in participants with metabolic syndrome versus those without it was 1.47 (95% CI 1.01–2.13). For those individuals of metabolic syndrome, hyperglycemia was most primarily related with the incidence of breast cancer (RR 1.44, 95% CI 1.02–2.04). Among the study individuals who were middle-aged Korean women, metabolic syndrome is highly related with the risk of breast cancer. Therefore, it needs to be managed or prevented to reduce the incidence of breast cancer.

Background: Approximately 2.7 million U.S. older adults self-identify as lesbian, gay, bisexual, and transgender (LGBT). Many felt unsafe revealing their sexual orientation until relatively recently, and may still not be “out” to medical providers. The aim of this study was to increase understanding of the experiences and needs of older LGBT adults when accessing care. Method: Individual semistructured interviews were conducted with 10 individuals aged 65 years or older from a local LGBT community. Interviews were audio taped and transcribed verbatim. Transcripts were analyzed via thematic analysis. Results: Major themes were “Outness,” “Things are Different Now,” and “Additional Resources.” These describe participant comfort with being “out”; how treatment they received changed over time, and needed services or other options from the community. Conclusion: While many older LGBT adults are accustomed to navigating social mores to avoid negative experiences, nurses as well as other health care providers must be prepared to create trusting relationships with these individuals to provide truly comprehensive care.

PURPOSE: This systematic review and meta-analysis evaluated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (A1C) levels in adult Latinos with type 2 diabetes (T2DM). METHODS: Five databases were searched for DSME randomized controlled trials or quasi-experimental trials published between January 1997 and March 2019. A random effects model was utilized to calculate combined effect sizes. Subgroup analyses were performed to explore possible sources of heterogeneity between studies. RESULTS: Twenty-three unique studies met criteria for this systematic review and of these, 18 were included in the meta-analysis. Pooled estimate effect of DSME on A1C from the random effect model was −0.240 (95% confidence interval = −0.345, −0.135, p < 0.001). There was moderate heterogeneity (Cochrane Q=30.977, P=0.020, I^2 = 45.121) between the studies. Subgroup analyses demonstrated greater A1C reductions in studies with intervention duration ≤6 months, initial A1C baseline values >8.0 [69 mmol/mol], and team-based approach. CONCLUSIONS: Meta-analysis results showed that culturally tailored DSME interventions significantly reduce AIC in Latinos with T2DM despite the heterogeneity across the studies. IMPLICATIONS: The heterogeneity in the study methodologies reinforce the need for additional studies to better understand DSME interventions to reduce disparities in Latino adults with T2DM.

Purpose/Aims: To describe the design and validation of a text message bank that will be used for an mHealth behavioral change intervention -- Fitness Intensive Therapy ( Get FIT+ ) in order to improve healthy eating and enhance physical activity in a sample of older adults (≥ 60 years) at risk for cardiovascular disease. Background: Short message service (SMS) has been widely used in patient follow-up and disease management, showing improvements in medication adherence, symptom monitoring, appointment attendance and satisfaction with health services. However, most studies usually focus on the effectiveness of SMS and lack information regarding the development and validation of their content to guarantee adequate understanding and appeal of SMS strategies by end users. Methods: An initial bank of 68 SMS text messages was developed to focus on healthy eating, physical activity and provide motivational feedback through an extant literature review for promoting behavior change to engage in healthy lifestyles. The messages were organized into three subsets [e.g., healthy eating (24 messages), physical activity (24 messages), other goals and compliance (20 messages)] for field validation. An expert panel (N = 5) evaluated each subset of SMS text messages. Consistent with the Get FIT+ project that will utilize the text messages, additional validation was conducted with 5 older adults (≥ 60 years old) from diverse ethnic backgrounds representative of the population in Orange County. Two to three people evaluated each of the three SMS text message subsets (N = 5, 40% male). User demographics, phone literacy, understanding and appeal of each SMS text message was assessed using a 27-item questionnaire. Results: The text message content included educational, motivational and goal progress feedback on the topics of nutrition, physical activity and compliance/other goals. Overall, the three SMS datasets received a total of 10 evaluations each. All evaluations—10 out of 10 (100%) valid responses—revealed an adequate understanding of the key idea contained in the SMS text message. The older adults’ average appeal score of the three datasets was 9.0 (SD±0.2) of 10 points. Participants did not make significant suggestions to change the wording of the messages, but provided excellent and useful feedback to optimize the messaging. Implications: The final set of SMS text messages produced had very high rates of understanding and appeal among an expert panel and older adults who represented the potential recipient. This study highlights the importance of developing and validating a database of simple, feedback-oriented SMS text messages, grounded in evidence and theory, with an expert panel and active engagement of potential end users.

Background and Purpose:The objective of this study was to formulate a MOMS Orange County program model to describe the components and function of a successful community-based maternal and infant health program.Methods:A logic framework was used to guide the development of the MOMS program model. Twenty-five MOMS staff members were interviewed; MOMS documents and existing research literature were reviewed. Content analyses were used to identify themes of interviews and the review guide was used to summarize the documents.Results:The key components of the MOMS program were identified to formulate a narrative and graphic model. The main elements of this model included: target population (underserved women who have low socioeconomic status and have limited access to healthcare in Orange County); theoretical assumptions (social determinants of health, human ecology, self-efficacy); goals (empower women, enhance health of infants, strengthen families); inputs (funded by public and private sources; 50 staff members); activities (care-coordination home visitation community-center group health education); outputs (the number of home visitations, referrals to medical and/or psychological services, and group health education classes); and outcomes (short-term: healthy pregnancy, birth outcomes, family support; medium-term: postpartum well-being, infant development, family functioning; long-term: women's well-being, children's development, family relationships. Future research should test how this model functions to empirically improve maternal, newborn, child, and family health.Implications for Practice:The MOMS program provides a new approach to community-based maternal and infant health interventions focusing on health promotion and disease prevention for underserved families in socioeconomically disadvantaged communities.

기미는 몇몇의 병인학적 요인을 갖고 있지만, 많은 연구가 멜라닌 형성에 집중되어 있다. 본 연구에서는 멜라닌 형성과 구별되는 혈관의 감소에 의한 기미의 개선을 보고자 하였다. 피부과 전문의의 육안평가를 통해 기미와 일광 흑자를 가진 한국 여성 20명을 대상으로 실험을 진행하였다. 연구 대상자는 8주 간 기능성 화장품을 사용하였다. Chromameter 기기로 측정한 연구 대상자의 기미 병변, 일광 흑자 병변 및 정상 피부 부위에서의 각 피부색 측정 결과를 분석하였다. 시료 사용 8주 경과 후, 기미 병변 부위의 피부색 밝기와 적색도가 정상 피부 부위에 비해 통계적으로 유의하게 개선되었다. 또한, 기미 병변 및 일광 흑자 병변 부위의 피부색 밝기의 개선 정도는 유사하였다. 그러나, 시료 사용 8주 경과 후 기미 병변 부위의 적색도가 일광 흑자 병변 부위에 비해 통계적으로 유의하게 개선되었다. 본 연구에서는 기능성 제품을 사용함으로써 기미 병변 부위에서 피부색 밝기 뿐만 아니라 적색도 또한 개선됨을 확인하였다. 이에 적색도가 기미 병변 부위의 평가를 위한 부가적이고 적합한 요인이 될 수 있음을 제시하고자 한다.

Aims and objectives To examine Korean registered nurses’ level of perceived knowledge and practice of venous thromboembolism risk assessment as well as prevention, self-efficacy in venous thromboembolism care and actual knowledge of venous thromboembolism. Background For hospitalised patients, venous thromboembolism is a preventable clinical disorder. Caring for venous thromboembolism patients requires coordination across multiple providers and settings. Clinical nurses can play a major role in improving venous thromboembolism prevention care, assessing venous thromboembolism risks and providing appropriate prophylactic measures to those who are at risk for venous thromboembolism. Design A cross-sectional descriptive study. Methods Anonymous paper-based surveys were conducted for a convenience sample of registered nurses’ (n = 452) from two university-affiliated hospitals in South Korea. Results The majority of participants indicated that their overall self-rated venous thromboembolism knowledge was ‘fair’, while only 2·4% rated it as ‘very good’ or ‘excellent’. The overall mean score of the venous thromboembolism knowledge questions was 50·9 (±13·0) of a possible score of 100. The mean score of self-efficacy in practising venous thromboembolism prevention/prophylaxis was 3·0 (based on a one to five Likert scale). The self-reported venous thromboembolism assessment performance on patients varied among clinical units. Only 9·3% of participants reported having received in-service venous thromboembolism education from their hospital. Conclusions The findings showed that overall venous thromboembolism knowledge and self-efficacy in venous thromboembolism prevention practices of Korean registered nurses’ were not highly rated. Korean nurses demonstrated a lack of knowledge about venous thromboembolism, particularly in the areas of venous thromboembolism prophylaxis measures and venous thromboembolism diagnosis methods. Relevance to clinical practice Focused education on venous thromboembolism prevention and risk assessment should be considered a component of continuing education for Korean nurses.

Background and Purpose Evidence about the efficacy of healthy pregnancy home visitation programs is needed in California’s underserved Hispanic population, where preterm birth rates are higher than nonHispanic Whites. This study describes birth outcome data in a sample of families participating in the MOMS Orange County home visitation program. Methods: A descriptive comparative design was used. Birth outcome data for 1,102 women who participated in MOMS Orange County and had a live birth in 2010 were compared with data from the county of Orange (N = 38, 237) and the state of California (N = 509, 979) for the same time period, derived from county and state birth and death reports. Measures included social background, birth outcomes, and potential cost savings. Results: Although MOMS program mothers were less educated and had a higher level of poverty compared to both county and state samples, they had significantly fewer preterm births compared with the countywide and statewide samples. It was estimated that the provision of a home visitation program both countywide and statewide would result in a potential cost saving that $1.1 and $ 2.1 million, respectively. Conclusion: This coordinated prenatal program may improve birth outcomes among communities of impoverished women at potentially reduced costs.

Background: Hypertriglyceridemia, a component of metabolic syndrome, is known to contribute to the development of atherosclerosis. The aim of this study is to evaluate the association between hypertriglyceridemia and dietary patterns using food frequency questionnaire data from the 2012 Korean National Health and Nutrition Examination Survey. Methods: We analyzed 1,994 subjects (796 men and 1,198 women) aged 40–65 years. Hypertriglyceridemia was defined as fasting triglyceride levels higher than 200 mg/dL. The association between dietary patterns and hypertriglyceridemia was analyzed after adjusting age, body mass index, total caloric intake, smoking status, and physical activity. The analysis was performed by multivariate logistic regression. Results: The prevalence of hypertriglyceridemia was 25.8% in men and 13.0% in women. The average amount of alcohol intake was significantly larger in hypertriglyceridemia patients in both men and women. In men, roast beef intake was associated with hypertriglyceridemia (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.07–6.97). In women, ORs of hypertriglyceridemia increased significantly in subjects who consumed higher fast foods (4.33; 1.71–10.96) roast-fried pork (3.50; 1.44–8.49) and processed pork (1.33; 1.12–4.85). Additionally, ORs of hypertriglyceridemia tended to increase as consumption of refined grains (P for trend 0.007) and fried rice (P for trend 0.023) was higher. Conclusion: Excessive intake of beef and alcohol consumption was significantly associated with hypertriglyceridemia in men. In women, fast foods, pork, rice and alcohol consumption were significantly associated with hypertriglyceridemia. The education of managing hypertriglyceridemia is needed among Koreans based on dietary patterns.

More of power wheelchair users’ needs have to be met in the making of power wheelchairs. However, there has been no usability scale for the power wheelchair that is specifically focusing on the users’ needs. The purpose of this study was to test and validate a usability scale for power wheelchairs (USPW). The USPW has been developed through interviews with power wheelchair and consultations with a panel of experts. The USPW consists of four evaluation categories (safety, operation, efficiency, and satisfaction). In order to validate it, its usability and the Quebec User Evaluation of Satisfaction Assistive Technology (QUEST) were also administered to 50 power wheelchair users. The USPW was extracted 12 items from safety, 7 from operation, 5 from efficiency, and 14 from satisfaction, with a total of 38 items. The content validity met the criteria. The total internal consistency (Cronbach’s [Formula: see text]) of the USPW was 0.75. Users of power wheelchair demanded that the safety of moving on the slopes, the satisfaction of storage space for power wheelchairs, and the repair service process would be improved. The correlation between the USPW and the QUEST was significant ([Formula: see text]). The USPW may be very useful to evaluate overall usability of power wheelchair including its safety, operability, efficiency, and satisfaction. The developed usability scale (USPW) may help wheelchair makers become aware of the problems of present power wheelchairs and the users’ needs, allowing them to make better ones.

Background Concerns over the creation of advance directives (ADs) and the factors associated with treatment directive decisions among Korean community-dwelling older people with chronic diseases have rarely been addressed. Objectives This study aimed to examine knowledge, attitudes and barriers/benefits regarding ADs and their associations with AD treatment preferences among chronically ill, low-income, community-dwelling older people. Methods Using a descriptive, correlational design, older people who were recipients of home visiting service for chronic disease management participated in this study. Home visiting nurses collected data on knowledge, attitudes and perceived barriers/benefits and treatment directives using questionnaires during home visits. Results Older people (N = 112, mean age = 74.9 years, women = 83.9%) who had chronic diseases such as hypertension (56.3%), diabetes mellitus (40.2%) and cardiovascular disease/stroke (22.3%) participated. Approximately half of the participants preferred hospice care (54.5%), while a few of them preferred aggressive treatments: cardiopulmonary resuscitation (CPR) (14.3%), ventilation support (9.8%) and haemodialysis (8.9%). Being married was associated with the likelihood of preferring CPR (odds ratio [OR] = 11.79) and ventilation support (OR = 9.99), higher education with CPR (OR = 1.23) and haemodialysis (OR = 1.16), and having a cardiovascular disease (CVD)/stroke with CPR (OR = 6.46) and hospice care (OR = 3.06). Among the modifiable factors, greater perceived barriers increased the likelihood of CPR preference (OR = 1.12) but decreased the likelihood of hospice care preference (OR = 0.96). Greater perceived benefits decreased the likelihood of CPR preference (OR = 0.81) and ventilation support (OR = 0.89), and AD knowledge decreased the likelihood of haemodialysis preference (OR = 0.23). Conclusion The multidimensional factors were differently associated with each of the AD treatment preferences. Modifiable factors, including perceived barriers and benefits and knowledge, should be improved to help low-income, community-dwelling older people select adequate AD treatment preferences. Implications for practice Additional information regarding AD treatments and some modifiable and non-modifiable correlates can be integrated into primary and palliative/supportive care in public health. The current home visitation service may also benefit from incorporating AD discussions while extending the service to embrace AD issues in addition to disease management.

BACKGROUND Few studies have been conducted in Korea on concordance regarding chronic diseases and lifestyle factors among couples. We, therefore, evaluated spousal concordance regarding lifestyle factors and chronic diseases among Korean couples. METHODS A total 1,040 participants (520 couples) who visited family physicians were recruited from 22 hospitals. All participants were aged ≥40 years. Participants completed questionnaires on smoking, drinking, physical activity, and irregular eating habits, including skipping breakfast. We estimated the spousal concordance regarding lifestyle factors and chronic diseases using McNemar tests and logistic regression analysis. RESULTS The concordance rate was high among couples who shared unhealthy behaviors, such as low physical activity, irregular diet, and skipping breakfast (P

Background: Latinos constitute 17% of the US population and are one of the largest ethnic groups; however, only 7.6% participate in research studies. There is a disproportionately high number of Latinos living with type 2 diabetes mellitus and are at increased risk for cardiovascular events. Research to elicit facilitators and barriers for participation in research and effective recruitment strategies is limited. Aims: This article reports the qualitative findings of a mixed-methods study examining perceived facilitators and barriers for research participation, and explores decision-making processes and ascertains ethnic values that influenced their decisions among Spanish-speaking Latinos with type 2 diabetes mellitus. Methods: Semi-structured interviews were conducted with 25 participants (mean age 50.8 ± 9.4 years, 76% women and 28% employed). Participants were asked to elaborate on perceived facilitators and barriers to research participation. All interviews were conducted in Spanish. Transcribed interviews were analyzed through conventional content analysis. Results: Three themes emerged from transcribed interviews: (a) lowering barriers to access health-related expertise; (b) language concordance; and (c) trusting relationships. Perceived barriers to research participation included work schedule, childcare, transportation and ethnic beliefs. Conclusion: Strategies to support learning, language concordance and establishing trusting relationships among Spanish-speaking Latinos may be key to increasing Latinos in research studies.

The purpose of this study is to analyze the effect of national cultural dimension and type of alliance orientation (scanning alliance, utilization alliance) on alliance performance. To analyze this objective, we conducted a survey in target companies which signed partnership and international business. This study reviews various literatures and developed a research model. To examine the research model, we collected data from international companies with partnerships. The study results showed that national culture and type of alliance orientation have a significant effect on the alliance performance. Moreover, it can provide a very meaningful implication where international firms achieve better performance identifying the core competencies between cultural characteristics and alliance orientation suitable for the partnership.

Objective: The aim of this study was to perform a usability test for CPAD (Cognitive Perceptual Assessment for Driving) and improve it based on the test results. Background: The cognitive perceptual assessment for driving is a computer-based assessment tool to assess the driving capacity of people with brain-damages. It may be a good tool for evaluating the brain-damaged drivers" safe driving capabilities and screening cognitive and perceptual deficits related to driving. We performed a usability test to improve the CPAD based on the result. Method: Both the software consisting of 8 sub-tests (depth perception, sustained attention, divided attention, stroop test, field dependency, digit span, trail making A, trail making B) and the hardware including the input and output devices (joystick, mouse, keyboard, touch screen) were evaluated through user interviews. Also we identified the problems and issues in using them by observing the participants performing the CPAD tasks. Results: Based on the results, the task instructions were visually and auditorily improved and more practice examples were added to help the users understand the instructions better and increase the input accuracy, a response time window was added and the joystick and touch screen were simplified, which made it easier for the user to perform the CAPD tasks. Conclusion: User discomforts were minimized by improving the task environment, unless it had affected the evaluation criteria. Application: We plan to distribute the improved version of the CPAD to the regional rehabilitation hospitals, and the driving support centers for people with disabilities throughout the country, so it could be used as an evaluation tool for disabled drivers" cognitive and perceptual functions.

A natural recombinant nephropathogenic K40/09 strain of infectious bronchitis virus (IBV) was heat-adapted for possible future use as live attenuated vaccine. The K40/09 strain was selected during successive serial passages in specific-pathogen free (SPF) embryonated eggs at sub-optimal higher temperature (56 °C). Unlike the parental strain, the attenuated strain, designated K40/09 HP50, was found to be safe in 1-day-old SPF chicks, which showed neither mortality nor signs of morbidity, and rarely induced ciliostasis or histological changes in the trachea and kidney after intraocular and fine-spray administration. K40/09 HP50 provided almost complete protection against two distinct subgroups of a nephropathogenic strain (KM91-like and QX-like subgroup) and elicited the production of high titers of neutralizing antibody (neutralization index of 3.6). We conclude that the K40/09 HP50 vaccine virus is rapidly attenuated by heat adaptation and exhibits the desired level of attenuation, immunogenicity, and protective efficacy required for a live attenuated vaccine. These results indicate that the K40/09 vaccine could be helpful for the reduction of economic losses caused by recently emergent nephropathogenic IBV infection in many countries.

This is one of the largest multicentered, cohort studies conducted to evaluate the proinflammatory biomarkers associated with cognitive impairment in breast cancer patients. While elevated interleukin (IL)-6 and IL-1β were observed in patients with poorer response speed performance and perceived cognitive disturbances, IL-4 may be protective against chemotherapy-associated cognitive impairment., Background Existing evidence suggests that proinflammatory cytokines play an intermediary role in postchemotherapy cognitive impairment. This is one of the largest multicentered, cohort studies conducted in Singapore to evaluate the prevalence and proinflammatory biomarkers associated with cognitive impairment in breast cancer patients. Patients and methods Chemotherapy-receiving breast cancer patients (stages I–III) were recruited. Proinflammatory plasma cytokines concentrations [interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, granulocyte–macrophage colony-stimulating factor, interferon-γ and tumor necrosis factor-α] were evaluated at 3 time points (before chemotherapy, 6 and 12 weeks after chemotherapy initiation). The FACT-Cog (version 3) was utilized to evaluate patients' self-perceived cognitive disturbances and a computerized neuropsychological assessment (Headminder™) was administered to evaluate patients' memory, attention, response speed and processing speed. Changes of cognition throughout chemotherapy treatment were compared against the baseline. Linear mixed-effects models were applied to test the relationships of clinical variables and cytokine concentrations on self-perceived cognitive disturbances and each objective cognitive domain. Results Ninety-nine patients were included (age 50.5 ± 8.4 years; 81.8% Chinese; mean duration of education = 10.8 ± 3.3 years). Higher plasma IL-1β was associated with poorer response speed performance (estimate: −0.78; 95% confidence interval (CI) −1.34 to −0.03; P = 0.023), and a higher concentration of IL-4 was associated with better response speed performance (P = 0.022). Higher concentrations of IL-1β and IL-6 were associated with more severe self-perceived cognitive disturbances (P = 0.018 and 0.001, respectively). Patients with higher concentrations of IL-4 also reported less severe cognitive disturbances (P = 0.022). Conclusions While elevated concentrations of IL-6 and IL-1β were observed in patients with poorer response speed performance and perceived cognitive disturbances, IL-4 may be protective against chemotherapy-associated cognitive impairment. This study is important because cytokines would potentially be mechanistic mediators of chemotherapy-associated cognitive changes.

© 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins. Background: The use of remote monitoring systems (RMSs) in healthcare has grown exponentially and has improved the accessibility to and ability of patients to engage in treatment intensification. However, research describing the effects of RMSs on activation, self-care, and quality of life (QOL) in older patients with heart failure (HF) is limited.Objective: The aim of this study was to compare the effects of a 3-month RMS intervention on activation, self-care, and QOL of older patients versus a reference group matched on age, gender, race, and functional status (ie, New York Heart Association classification) who received standard discharge instructions after an acute episode of HF exacerbation requiring hospitalization.Methods: A total of 21 patients (mean age, 72.7 ± 8.9 years; range, 58-83 years; 52.4% women) provided consent and were trained to measure their weight, blood pressure, and heart rate at home with an RMS device and transmit this information every day for 3 months to a centralized information system. The system gathered all data and dispatched alerts when certain clinical conditions were met.Results: The baseline sociodemographic and clinical characteristics of the 2 groups were comparable. Over time, participants in the RMS group showed greater improvements in activation, self-care, and QOL compared with their counterparts. Data showed moderately strong associations between increased activation, self-care, and QOL.Conclusion: Our preliminary data show that the use of an RMS is feasible and effective in promoting activation, self-care, and QOL. A larger-scale randomized clinical trial is warranted to show that the RMS is a new and effective method for improving clinical management of older adults with chronic HF.

Coxsackievirus belongs to the Enterovirus genus of the Picornaviridae family and is one of the major pathogens associated with human hand, foot, and mouth disease (HFMD). Historically, outbreaks of HFMD have mainly been caused by enterovirus 71 and coxsackievirus A16. Recently, coxsackieviruses A6 and A10 have been associated with increased occurrences of sporadic HFMD cases and outbreak events globally. In this study, the immunogenicity of coxsackieviruses A6, A10, and A16 (CA6, CA10, and CA16), which were inactivated by formalin or β-propiolactone (BPL) under different conditions, was evaluated as multivalent vaccine candidates. CA6 induced similar immune responses with both inactivation methods, and the immune efficacy of CA10 and CA16 was better following inactivation with BPL than with formalin. There was no sufficient cross-reactivity or cross-protectivity against heterologous strains in groups vaccinated with the BPL-inactivated (BI) monovalent vaccine. Sufficient neutralizing antibody and cell-mediated immune responses were induced in the BI-trivalent vaccinated group. These findings suggest that BI-CA6, CA10, and CA16 are potential multivalent vaccine candidates and that a multivalent vaccine is needed to control HFMD. The coxsackievirus multivalent vaccine could be useful for the development of effective HFMD vaccines.