The purposes of this study were to evaluate symptom experience and quality of life (QOL) and to identify the predictors of QOL among breast cancer survivors. Methods: A cross-sectional study was conducted on 200 disease-free breast cancer survivors at two hospitals between December 2007 and July 2008. Functional Assessment of Cancer Therapy Scale-B, Memorial Symptom Assessment Scale-short Form and The Linear Analogue Self Assessment Scale were used to assess symptom experience and QOL in these patients. Data were analyzed using the Pearson correlation, t-test, ANOVA, and stepwise multiple regression with SPSS/WIN 12.0. Results: The mean score of QOL for breast cancer survivors was 95.81 (${\pm}18.02$). The highest scores among physical and psychological symptoms were sexual interest and anxiety. Year since treatment completion was significantly associated with QOL in sociodemographic variables. Physical and psychological symptoms have a significant negative association with QOL. The results of the regression analyses showed that physical and psychological symptoms were statistically significant in predicting patients' QOL. Conclusion: Symptom experience and QOL are essential variables that should be acknowledged when delivering health care to breast cancer survivors. More attention to the reduction and management of psychological distress could improve QOL among breast cancer survivors.

Purpose: This study was conducted to analyze the factors that influence the life satisfaction of the elderly according to their cognitive impairment level. Methods: This study was conducted by dividing 3,012 elderly residents of a regional community into three groups based on the scores of the Korean version of the Mini-Mental State Examination: a normal group without any cognitive impairment, a suspicious group with a mild level of cognitive impairment, and a high risk group with a high level of cognitive impairment. Researchers made phone calls, house calls, and personal visits to health centers and shelters for the elderly to gather the information required for this study. Results: The results of this study revealed that social relationships, depression, and activities of daily living had a significant impact on life satisfaction for the normal group, while social relationships and depression had a high impact on life satisfaction for the suspicious group, and social relationships had high impact on the life satisfaction of the high risk group. Conclusion: Based on the results of this study, we suggest that programs that promote development of the social relationship networks of the elderly should be established to promote their life satisfaction.

Purpose: The purpose of this study was to examine the effect of DHEA (Dehydroepiandrosterone) on muscle weight and Type I and II fiber cross-sectional area of affected and unaffected hindlimb muscles in rats with neuropathic pain induced by unilateral peripheral nerve injury. Methods: Neuropathic pain was induced by ligation and cutting of the left L5 spinal nerve. Adult male Sprague-Dawley rats were randomly assigned to one of two groups: The DHEA group (n=10) had DHEA injections daily for 14 days, and the Vehicle group (n=10) had vehicle injections daily for 14 days. Withdrawal threshold, body weight, food intake and activity were measured every day. At 15 days all rats were anesthetized and soleus, plantaris and gastrocnemius muscles were dissected from the both hindlimbs. Body weight, food intake, activity, muscle weight and Type I, II fiber cross-sectional area of the dissected muscles were measured. Results: The DHEA group showed significant increases (p<.05), as compared to the vehicle group for muscle weight of the unaffected plantaris, and in Type II fiber cross-sectional area of the gastrocnemius muscle. The DHEA group demonstrated a higher pain threshold than the vehicle group whereas total diet intake and activity score were not significantly different between the two groups. Conclusion: DHEA administration for 14 days attenuates unaffected plantaris and gastrocnemius muscle atrophy.

Purpose: This study was done to examine the difference in cancer screening with mammography and Papanicolaou smear according to Body Mass Index (BMI). Methods: The participants in this study were 5,912 women ages 40 to 69 yr, selected from the Korean Genomic Regional Cohort in Kangwon province. Mammography and Papanicolaou smear were assessed by questionnaire and body weight (kg) and height (m) measured to calculate BMI. Results: The distribution of BMI was as follows: low weight (1.5%), normal weight (31.1%), over weight (24.6%), mildly obese (36.4%) and severely obese (6.3%). After adjusting for age, education and monthly income, compared with normal weight women, overweight women (odds ratio [OR]=1.283, 95% confidence interval [CI]=1.089-1.513) and mildly obese women (OR=1.214, 95% CI=1.048-1.406) were less likely to have had mammography. In contrast to mammography, cancer screening with Papanicolaou smear was not significantly different by BMI. Conclusion: Obese women in rural areas are less likely to screen for breast cancer by using mammography than non obese women. To ensure regular screening for breast cancer, health care providers need to give scrupulous care to obese women and remove barriers originated from obesity. Also, educational and clinical implications are considered to increase the Papanicolaou smear rate.

Purpose: This study was done using meta-analysis to examine 58 studies from studies published in the past eight years (2000 to 2007) that included variables related to adolescents' suicidal ideation. Methods: The materials for this study were based on 32 variables which were selected from masters' thesis, doctoral dissertation and articles from Journals of the Korean Academy of Nursing. Results: The classification consisted of 5 variables groups and 32 variables. In terms of effect size on risk, variables which were significant included psychological variables (0.668), socio-cultural variables (0.511), family environmental variables (0.405), school environmental variables (0.221), and personal characteristics variables (0.147). In terms of effect size on protection, variables which were significant included personal characteristics variables (-1.107), psychological variables (-0.526), family environmental variables (-0.264), and school environmental variables (-0.155). In terms of effect size on risk variables, psychological variables (0.668) were highest. In terms of effect size on protective variables, the variable of personal characteristic (-1.107) was the highest. Conclusion: While the results indicate possible risk and protective variables for suicidal ideation, but prediction is still difficult. Further study to compare adolescents with similar variables but no suicidal ideation and those with suicidal ideation is necessary.

Purpose: This study was to examine the effects of self-foot reflexology on stress, fatigue and blood circulation in premenopausal middle-aged women. Methods: A quasi-experimental nonequivalent control group, pretest-posttest design was used. Participants were 59 premenopausal, middle-aged women in their 40s and 60s living in G city: 30 in the experiment group and 29 in the control group. Data were collected from May to August 2008. Self-foot reflexology was performed three times a week for 6 weeks for 40 min at each session. Results: The results showed that self-foot reflexology was effective in reducing perceived stress and fatigue and helped blood circulation in premenopausal middle-aged women. Conclusion: Self-foot reflexology may be an effective nursing intervention in reducing perceived stress and fatigue and in improving blood circulation.

Purpose: This study was done to develop a model which explains factors influencing caring behavior of mothers who have children with disabilities, and to verify the appropriateness of the model and the relationship among variables. Methods: The participants in the research were the mothers who had a 3 to 12 yr-old children with disabilities. The data were collected from 451 mothers through self-reported questionnaires from July 14 to 31, 2008. A total of the 371 data sets were analyzed using SPSS/WIN 11.5 and AMOS 5.0 version. Results: The children's behavior characteristics, social support, objective burden and parenting self-esteem had an impact on the mothers' caring behavior. Especially, parenting self-esteem including parenting satisfaction and self-efficacy was the most influential factor. These variables explained 77% of the mothers' caring behavior for these children. Conclusion: The results suggest that some strategies for promoting mothers' parenting self-esteem focused on parenting satisfaction and self-efficacy should be developed in order to help mothers in caring for their child who is disabled.

Purpose: The purpose of this study was to identify cancer-related symptom clusters and to validate the conceptual meanings of the revealed symptom clusters in patients with hepatocellular carcinoma. Methods: This study was a cross-sectional survey and methodological study. Patients with hepatocellular carcinoma (N=194) were recruited from a medical center in Seoul. The 20-item Symptom Checklist was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with varimax rotation. To validate the revealed symptom clusters, the statistical differences were analyzed by status of patients' performance status, Child-Pugh classification, and mood state among symptom clusters. Results: Fatigue was the most prevalent symptom (97.4%), followed by lack of energy and stomach discomfort. Patients' symptom severity ratings fit a four-factor solution that explained 61.04% of the variance. These four factors were named pain-appetite cluster, fatigue cluster, itching-constipation cluster, and gastrointestinal cluster. The revealed symptom clusters were significantly different for patient performance status (ECOG-PSR), Child-Pugh class, anxiety, and depression. Conclusion: Knowing these symptom clusters may help nurses to understand reasonable mechanisms for the aggregation of symptoms. Efficient symptom management of disease-related and treatment-related symptoms is critical in promoting physical and emotional status in patients with hepatocellular carcinoma.

Purpose: The purpose of this study was to identify congruence between self-perception and objective status of obesity according to %Fat, and to investigate health promotion lifestyle in college women. Methods: The participants were a convenience sample of 392 college women who were eligible and agreed to participate in this study. Respondents were asked questions using a health promotion lifestyle profile and were evaluated for their body composition using InBody 3.0. The data were analyzed with SPSS 14.0 program, which was used for Chi square, ANOVA, and post-hoc comparison with Scheffe. Results: The major findings were as follows; 1) Overall, 41.8% of participants misclassified their perceived status of weight by %Fat standards and kappa was 0.329. 2) Two percent were underweight by BMI but overweight by %Fat and 39.0% normal weight by BMI but overweight by %Fat. 3) There were significant differences in health promotion lifestyle according to self-perception of body weight but there was no difference in health promotion lifestyle according to %Fat standards. Conclusion: These findings suggest the necessity for development and application of tailored health promotion program based on self-perception of body weight and %Fat in order to reform incorrect body image and health behavior in college women.

Purpose: This study was done to test the validity and reliability of the Adolescent Mental Problem Questionnaire (AMPQ) for Korean high school students. Methods: The AMPQ was designed to assess adolescents', mental health status and problem behavior (Ahn, 2006). A methodological study design was used with exploratory factor analysis, Pearson's correlation coefficients, and a fitness of the modified model for validity. Also, Cronbach's alpha coefficients and alternative-form method for reliability were used. AMPQ was tested with a sample of 36,313 high school students. The participants consisted of 18,701 males and 17,612 females. Results: Seven factors were extracted through factor analysis: 'Psychiatric problems', 'Delinquency', 'Academic troubles', 'Family problems', 'Hazardous behavior', 'Harmful circumstance', 'Eating problems'. These factors explained 51.1% of the total variance. The fitness of the modified model was good ($X^2$=38,413.76, Goodness of Fit Index [GFI]=.94, Adjusted Goodness of Fit Index [AGFI]=.93, Comparative Fit Index [CFI]=.95, Root Mean Square Error of Approximation [RMSEA]=.05), and concurrent validity with Korea-Youth Self-Report [K-YSR] was .63. Cronbach's alpha coefficient of the 31 items was .85. Conclusion: The results of present study suggest that the modified AMPQ instrument may be useful for efficiently assessing mental health status and problem behavior in late adolescent, high school students.

Purpose: The study was done to investigate physical assessment skills used by, and educational needs of, advanced practice nurses (APNs) and nurse specialists in Korea. Methods: A total of 123 APNs and nurse specialists working in five major hospitals in Seoul were surveyed from July 15 to August 20, 2007. Results: Fourteen skills out of 126 items were reported as being performed on a regular basis by participants. The majority of these skills involved general observation. Forty-six skills were rarely used. Some participants showed a lack of confidence in certain assessment skills, such as in doing a rectal or pelvic exam, and the use of some assessment equipment. Over 90% of participants required in-depth education on health assessment provided by specialists or nursing professional organizations. Conclusion: More educational opportunities in physical assessment should be provided including education programs based on the nurses' skill levels and needs. This effort will help to increase confidence of APNs and nurse specialists in physical assessment skills, ultimately resulting in better nursing outcomes.

Purpose: The purpose of this study was to test the effects of tailored diabetic education on blood glucose control and self-care for patients with type 2 diabetes on insulin therapy. Methods: The participants were 60 patients (experimental group: 30, control group: 30) with type 2 diabetes on insulin therapy. The patients were being seen at a university hospital in Seoul, Korea. Group diabetic education and tailored diabetic education were given to the experiment group while group diabetic education only was given to the control group. Data were collected before and three months after the education. $X^2$ test, t-test, and ANCOVA were used to analyze the data. Results: No significant differences in postprandial (PP2hrs) glucose and HbA1c levels were found between the two groups. Participants in the experiment group showed statistically significant differences in the area of self-glucose test, management of insulin injection, and life style change compared to those in the control group. Conclusion: The results indicate that tailored education for patients with diabetes on insulin therapy improve self-glucose test, management of insulin injection, and life style. Therefore it is suggested that tailored education can be applied in diabetic education to improve self-care.

Purpose: The purpose of this study was to identify the moderating and mediating effects of self-leadership in the relationship between organizational culture and nurses' informatics competency. Methods: Participants in this study were 297 nurses from the cities of Busan and Ulsan. The scales of organizational culture, self-leadership and informatics competency for nurses were used in this study. Descriptive statistics, Pearson correlation coefficient, stepwise multiple regression were used for data analysis. Results: Nursing informatics competency of the participants was relatively low with a mean score 3.02. There were significant positive correlations between subcategories of perceived organizational culture, self-leadership and nursing informatics competency. Self-leadership was a moderator and a mediator between organizational culture and informatics competency. Conclusion: Based on the results of this study, self-leadership promotion strategies to improve nursing informatics competency are needed.

Purpose: The purpose of this study was to identify the prevalence of cognitive impairment, behavioral problems, and the state of mental health for elderly Korean people who have been institutionalized. Methods: A cross-sectional, nationwide survey was performed using an anonymous questionnaire. The participants in this study were 2,521 institutionalized elderly Korean people. A proportional stratified random sampling method was employed. Results: 1) Elders admitted to subacute hospitals and long term care (LTC) facilities showed a higher level of cognitive impairment compared to elders admitted to acute care hospitals. 2) Elders confined in LTC facilities showed a higher level of behavioral problems compared to elders in acute or subacute hospitals. 3) Elders admitted to subacute hospitals and LTC facilities showed more serious mental health problems, such as depression or suicidal ideation, compared to elders in acute care hospitals. Conclusion: The results of this study indicate that the severity of cognitive-behavioral or mental health problems do not match well with type of care setting. Therefore, health personnel working with elderly people should be provided guidance on detection and management of cognitive-behavioral and mental health problems. The necessity of a decision support system for eligibility and placement in long-term care is also discussed.

Purpose: The purpose of this study was to investigate the Quality of Life (QOL) and related factors in the patients with dizziness. Methods: The data were collected between March and June 2008 for 200 individuals who agreed to participate in the study. Uncertainty (Uncertainty in illness scale), anxiety, depression (Hospital anxiety & depression scale) and Vestibular disability activities of daily living (Vestibular disability-activities of daily living [ADL] scale) as well as QOL (Dizziness Handicap Inventory) were measured. Results: The mean QOL score was 37.5 (${\pm}23.0$). Monthly income, etiology of, frequency of, and total duration of dizziness were the significant factors related to QOL in these patients. Having had a fall, anxiety, depression, uncertainty and vestibular disability in daily living were also significant factors influencing QOL. In multiple regression analysis, anxiety, vestibular disability-ADL, falls, total duration of symptoms, uncertainty, and etiology of dizziness explained 41% of variance of QOL. Conclusion: The level of QOL in our patients was moderate as compared to those in previous studies. Anxiety and vestibular disability were the most important factors predicting low QOL. Use of nursing intervention programs designed to relieve these factors should also result in improving the QOL in the patients with dizziness.