Purpose: The purpose of the study was to investigate psychological factors such as eating psychopathology, depression, and obsessive-compulsion that might influence self-harm behavior in patients with eating disorders. Methods: Patients with eating disorders (n=135) who visited "M" clinic for eating disorders participated in the study. Data were collected from March to August 2007 using the Eating Disorder Inventory-2, Beck Depression Inventory, Maudsley Obsessional-Compulsive Inventory, and Self-Harm Inventory (SHI). Results: The participants scored high on self-harm as well as on depression and obsessive-compulsion. On the SHI, a high frequency of self harm behavior such as 'torturing self with self-defeating thoughts', 'abused alcohol', 'hit self', and 'suicide attempt' were found for the participants. There were significant correlations between most eating psychopathology variables, depression, obsessive-compulsion, and self-harm behavior. 'Interoceptive awareness' (eating psychopathology), depression, and 'checking' (obsessive-compulsion) were significant predictors of self-harm behavior. Conclusion: Future interventions for patients with eating disorders should focus on assessing the possibility of self-harm and suicidal attempts, especially in those patients with high levels of eating psychopathology, depression, or obsessive-compulsion. Early intervention for depression and obsessive-compulsion could contribute to preventing self-harm and suicide in patients with eating disorders.

Purpose: The purpose of this study was to identify the effectiveness of public health center smoking cessation counseling program using the transtheoretical model on the process of change, smoking temptation, decisional balance and stage change transition. Methods: A nonequivalent control group non-synchronized design was used for this study. The study population was 115 adult smokers. The counseling program was administered to the experimental group and a smoking cessation program from the Korean Ministry of Health & Welfare was administered to the control group. Descriptive analysis, $\chi^2-test$, t-test, and ANCOVA were used with the SPSS 12.0 program to analyze the data. Results: After treatment with this program, the experimental group showed significantly higher scores for process of change (t=4.148, p<.001), smoking temptation (t=-2.988, p=.003), and stage change transition ($\chi^2=5.871$, p=.031) compared to the control group. Experimental group members also showed significantly lower score for Pros of smoking (t=-3.151, p=.002). Conclusion: The findings indicate that this program could have positive effect on process of change, smoking temptation, decisional balance and stage transition for adult smokers. Based on these findings, the authors suggest additional counseling program focusing on smokers in specific stages.

Purpose: The purpose of this study was to identify the factors which influence health-related quality of life (HRQoL) in Korean Medicaid beneficiaries. The relationships among sociodemographic factors, health status, health behavior, and HRQoL were analyzed. Methods: Data from the 2007 survey on Health Services Use and Health Status of Medicaid Beneficiaries conducted by the Ministry for Health Welfare and Family Affairs were examined. To analyze the sample survey data, descriptive statistics, correlation and hierarchical multiple survey regression analysis with SAS 9.1.3 package were used with SURVEYMEANS and SURVEYREG procedures, which incorporate the sample design into the analyses in order to make statistically valid inference for the whole Medicaid population. Results: The HRQoL correlated with limitations in Activities of Daily Living (ADL) (r=-.509, p<.001), stress (r=-.387, p<.001), depression (r=-.385, p<.001), alcohol consumption (r=.216, p<.001), and exercise (r=.293, p<.001). Significant factors that affect HRQoL of Medicaid beneficiaries were gender, region, limitations in ADL, stress, depression, alcohol consumption, and regular exercise. These variables explained 44.6% of HRQoL (F= 215.00, p<.001). Conclusion: The results indicate that to improve the HRQoL of Medicaid beneficiaries it is important to develop nursing intervention programs that focus on psychological health and health behavior and to give consideration to differences in gender and region.

Purpose: This study was done to identify the effects of a Human Papillomavirus (HPV) linked to cervix cancer prevention education program for unmarried university female students. A new model in the cervix cancer prevention is provided. Methods: The research design was a nonequivalent control group pretest-posttest design. Participants were 63 female students in one of two university in an experimental group (29 students) and control group (34 students). After 4 weeks education, the differences between the two groups in the measurement variables were compared. Twelve weeks later, a follow-up test was done for experimental group only. Results: After the education, experimental group showed significantly higher scores in all variables, the intention for Pap test (Z=-3.73, p<.001), intention for HPV vaccination (Z=-3.14, p=.002), general cancer prevention behavior (Z=-2.20, p=.028), attitudes to Pap (Z=-3.23, p=.001), benefits of cancer prevention behavior (Z=-3.97, p<.001), and HPV linked to cervix cancer knowledge (Z=-5.40, p<.001). In the follow-up study, the experimental group showed intermediate effects in intention for Pap test, intention of HPV vaccination and HPV linked to cervix cancer knowledge as well as short term effects in general cancer prevention behavior, attitudes to Pap and benefits of cancer prevention behavior. Conclusion: The program developed for this study on prevention education of HPV linked to cervix cancer was effective for unmarried university students in the short term and intermediate duration. Other educational approaches should be developed and short term effects and longitudinal changes of the education should be assessed. This education program should also be replicated for other female groups including unmarried working women or female adolescents.

Purpose: This study was conducted to identify the factors that influence nurses' organizational citizenship behavior. Methods: A cross-sectional design was used, with a convenience sample of 547 nurses from four university hospitals in Seoul and Gyeonggi province. The data were collected through a questionnaire survey done from September 22 to October 10, 2008. The tools used for this study were scales on organizational citizenship behavior (14 items), self-leadership (14 items), empowerment (10 items), organizational commitment (7 items), job satisfaction (8 items) and transformational transactional leadership (14 items). Cronbach's alpha and factor analysis were examined to test reliability and construct validity of the scale. The data collected were processed using SPSS Window 15.0 Program for actual numbers and percentages, differences in the dependent variable according to general characteristics, and means, standard deviations, correlation coefficients and multiple regression analysis. Results: The factors influencing nurses' organizational citizenship behavior were identified as self-leadership ($\beta=.247$), empowerment ($\beta=.233$), job satisfaction ($\beta=.209$), organizational commitment ($\beta=.158$), and transactional leadership ($\beta=.142$). Five factors explained 42.0% of nurses' organizational citizenship behavior. Conclusion: The results of this study can be used to develop further management strategies for enhancement of nurses' organizational citizenship behavior.

Purpose: Despite recent advances in the surgical and postoperative management of infants with congenital heart disease, nutritional support for this population is often suboptimal. The purpose of this study was to develop a nutritional program for the postoperative period for infants who have had cardiac surgery and to evaluate effects of the program. Methods: A quasi-experimental design with pretest and posttest measures was used. A newly developed nutritional program including a feeding protocol and feeding flow was provided to the study group (n=19) and usual feeding care to the control group (n=19). The effects of the feeding program were analyzed in terms of total feed intake, total calorie intake, gastric residual volume, and frequency of diarrhea. Results: Calorie intake and feeding amount in the study group were significantly increased compared to the control group. However, the two groups showed no significant differences in gastric residual volume and frequency of diarrhea. Conclusion: The results indicate that the nutritional program used in the study is an effective nursing intervention program in increasing feeding amount and calorie intake in infants postoperative to cardiac surgery and does not cause feeding-related complications.

Purpose: The purpose of this study was to identify factors influencing quality of life in kidney transplant recipients and to understand the concrete pathway of influence and the power of each variable, so that integrated prediction model to promote the quality of life of kidney transplant recipients could be developed. Methods: The sample was composed of 218 patients in follow-up care after a kidney transplant in one of 4 university hospitals in the Honam area. A structured questionnaire was used and the collected data were analyzed for fitness, using the LISREL program. Results: This model was concise and extensive in predicting the quality of life of kidney transplant recipients. Conclusion: The research verified the factors influencing quality of life for kidney transplant recipients and it verified that direct factors such as perception of health state, compliance, self-efficacy, stress and indirect factors such as self-efficacy and social support can be important factors to predict the quality of life for recipients. Moreover, those variables represent 87% of variance in explaining quality of life in a prediction model so that the variables can be utilized to predict quality of life for kidney transplant recipients.

Purpose: This study was done to develop and test a palliative care program based on home care nursing. Methods: A quasi-experimental design was employed. Changes in the variables were evaluated to test effects of the developed program. Participants were patients with terminal cancer and their families receiving home care nursing from six hospitals (experimental group: 24 and control group: 22). Data collection was conducted from February to October, 2006. Chi-square test, Fisher's exact test, t-test, Mann-Whitney U test and repeated measures ANOVA were used to analyse the data. Results: Hypothesis 1, the experimental group receiving this program will experience less pain (severe, average, weak pain) than the control group, was supported. Hypothesis 2, the experimental group will have less symptom experience than the control group, was supported. Hypothesis 3, the experimental group will have higher QOL than the control group, was supported and the last hypothesis 4, family burden in the experimental group will be less than the control group, was supported. Conclusion: The home care nursing based palliative program developed in this study was found to be an effective program to reduce patient pain and symptom experience, to improve patient QOL and to decrease family burden.

Purpose: This study was designed to construct and test the structural equation model on sexual satisfaction in patients with a colostomy. Methods: The model construction was based upon Roy's adaptation model. Stoma-related discomfort (SRD), age, frequency of sexual intercourse, treatment modality, and gender affect sexual satisfaction and are mediated by physical, psychosocial, and interdependence modes. Each mode was conceptualized as sexual function, body image/ depression, and marital intimacy. The patients were 112 colostomates with colorectal cancer who were asked to complete a mail-back survey on their demographic data, SRD, body image, depression, marital intimacy, sexual function, and sexual satisfaction. Data were analyzed using SPSS WIN 15.0 and AMOS WIN 7.0. Results: Significant variables for sexual satisfaction in the final model were body image affected by SRD, depression affected by body image and SRD, marital intimacy affected by depression, and sexual function affected by marital intimacy. Conclusion: The results of this study suggest that specific guidelines for SRD are necessary to improve sexual satisfaction among colostomates. Nurses should be vigilant in monitoring depression and body image disturbance, and providing appropriate interventions to increase marital intimacy. Treatment modality, gender, and age should be considered in developing education programs pertaining to sexuality.

Purpose: Work-related stress and risk factors among Korean employees were identified in this study. Methods: Data were obtained from employees aged 20 to 64 using the Korean Working Conditions Survey 2006 (KWCS). Multiple logistic regression analysis using SAS version 9.1 was performed to examine risk factors of work-related stress by gender. Results: The age-adjusted prevalence of work-related stress among male and female employees was 18.4% and 15.1% respectively. After adjustments for multiple variables among both male and female employees, there was a significant relationship between work-related stress and risk factors including education, company size, work time, ergonomic risks, biological chemical risks, and job demands. The significant variables for male employees were housework load, occupational class, and shift work, and for female employees, type of employment. Conclusion: There is a need to develop and support intensive stress management programs nationally giving consideration to work-related stress associated with working time, physical working environment, and job demands. Based on gender specific approaches, for male employes, stress management programs should be developed with consideration being given to occupational class and shift work. For stress management programs for female employees, consideration needs to be given to permanent employment status, specifically those in small companies.

Purpose: The purpose of this study was to identify the effects on the cognitive function, Activities of Daily Living (ADL), mood, social behaviors, and problematic behaviors of robot pet-assisted program for elderly people with dementia. Methods: This study was a nonequivalent control group pretest-posttest design. The participants were 32 elders with dementia. Seventeen were assigned to the experimental group and 15 to the control group. The intervention was conducted twicea week for 6 weeks. Results: 1) After the program, cognitive function, ADL, and social behaviors did not show significant differences. 2) After the program, mood of experimental group was significantly better than that of the control group. 3) After the program, problematic behaviors of the experimental group were significantly more diminished than those of control group. 4) As a result of analyzing the response, robot pet-assisted program was effective such as inducing a positive emotional state and increasing communication and interaction. Conclusion: The robot pet-assisted program was effective in changing the mood and diminishing problematic behaviors and had positive effects such as increasing communication and interaction for elders with dementia. Therefore, this program should be considered as a positive program for physical and emotional support for elders with dementia.

Purpose: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. Methods: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. Results: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. Conclusion: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

Purpose: The purpose of this study was to investigate the effect of stretching, muscle strengthening, and walking exercise on the cardiopulmonary function and health-related quality of life in hemodialysis patients. Methods: Twenty-one patients in the intervention and the control group participated in the exercise respectively on maintenance hemodialysis at four university hospitals. The exercise was composed of 20 to 60 min per session, 3 sessions a week for 12 weeks. The effect of exercise was assessed by cardiopulmonary function (peak oxygen uptake, peak ventilation, peak respiration rate, maximal heart rate, and exercise duration) using a cycle ergometer. Grip strength was measured by dynamometer, and flexibility was measured by sit and reach measuring instrument. Health-related quality of life was measured using Medical Outcomes Study Short Form-36. Results: Peak oxygen uptake, peak ventilation, peak respiration rate, exercise duration, grip strength, flexibility, and physical component scale were significantly improved in the intervention group after 12 week's exercise compared to the control group. Conclusion: These findings indicate the exercise can improve cardiopulmonary function, grip strength, flexibility, and physical component scale of health-related quality of life in hemodialysis patients.

Purpose: The goal of this study was to evaluate the impact of life style characteristics on the prevalence risk of metabolic syndrome (MS). Methods: A total of 581 adults were recruited from a cardiovascular outpatient clinic. A newly developed comprehensive life style evaluation tool for MS patients was used, and patient data related to the MS diagnosis were reviewed from the hospital records. Results: The overall prevalence of MS was 53.2%, and the mean of MS score was 2.6 for patients at a cardiovascular outpatient clinic (78% of the patients had hypertension). Dietary habits among the life style characteristics had significant influence on the prevalence risk of MS and MS scores. And also interestingly, the classification and regression tree (CART) model suggested that the high prevalence risk groups for MS were older adults (61.5$\leq$age<79.4), and adults between 48.5 and 61.5 yr of age with bad dietary habits. Conclusion: This study indicates that nurses should focus on dietary habits of patients (especially patients classified as high prevalence risk for MS) for improvement and prevention of MS prevalence risk.

Purpose: The purpose of this study was to identify type of anger expression and mental health in middle aged women. Methods: From August to October 2005, survey data were collected by using the State Trait Anger Expression Inventory and Symptom Check List-90-Revision (SCL). Participants (1,442) were classified into four types of anger expression by K-mean cluster analysis. For collecting interview data for content analysis, 18 participants (4-5 participants from each type of anger expression) were recruited. The interview data were collected between March and September 2006. Results: The average score of the state anger of middle-aged women was 11.95, and that of the trait anger was 18.75. The average anger expression scores were 12.72 for Anger-In, 13.45 for Anger-Out, and 18.51 for Anger-Control. The average SCL scores were 45.03 for somatization, 42.23 for obsessive-compulsiveness, 42.44 for interpersonal sensitivity, 42.45 for depression, 42.40 for anxiety, 42.62 for hostility, 44.44 for phobic anxiety, 43.65 for paranoid ideation, and 43.08 for psychoticism. The anger expression types identified in this study were 1) anger-out in secret, 2) anger-control with a patience, 3) anger-out with suppression, and 4) low anger expression type. The psychosomatic symptom scores were the highest in type III (anger-out with suppression), and the lowest in type IV (low anger expression type). Conclusion: This study can be helpful in assisting middle aged women to control their anger effectively and may contribute to the improvement of their mental health.