• Title/Summary/Keyword: Chronic disease management

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An Effect of the Self-Regulation Program for Hypertensives -Synthesis & testing of Orem and Bandura's theory- (본태성 고혈압 환자의 자가간호증진을 위한 자기조절 프로그램 효과 -Orem이론과 Bandura이론의 합성과 검증-)

  • Park, Young-Im;Hong, Yeo-Shin
    • Research in Community and Public Health Nursing
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    • v.5 no.2
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    • pp.109-129
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    • 1994
  • Chronic health problems has become a major concern and challenge to the health care professionals today. Especially hypertension, one of the leading primary cause of death in Korea, is a typical chronic disease requiring adequate and continuous management. Though these hypertensives need to maintain desirable health practice by themselves for their life time, many previous studies indicated that most of the essential hypertensives have no specific symptoms and thus, reluctant to follow appropriate medical regimens causing the condition further aggravated and complicated. Self-care is an essential factor that keeps chronic patients in control of their health and wellness. Thus this study was conducted to identify the effect of the comprehensive self-regulation program as a nursing intervention on the promotion self-care performance and improvement in physical parameters of hypertensives. For this purpose, a one group quasi-experimental research with pre and post test design was used. The subjects of the study was consisted of thirty persons with mild or moderate essential hypertension from two companies in Cheong-ju city. The whole program was carried out from October, 1993 to February, 1994. The self-regulation program was consisted with group education on hypertension and self-care, self-regulation including the blood pressure self-monitoring and recording, recording of daily self-care activities, and encouraging and reinforcing self-efficacy through verbal persuation and enactive attainment. The subjects were asked to measure their own blood pressure by themselves twice per day and to record blood pressure and the daily self-care performance according to the instructions provided during the whole period of 9 weeks. The instruments used for data collection in this study were as follows : 1) Instruments used for measuring the knowledge about hypertension, multiple health locus of control, and perceived benifits and barriers were adapted from previous studies and modified by author to be fit for the subjects. 2) Self-efficacy scale and self-care performance record were developed by the author. 3) Physiological parameters included systolic / diastolic blood pressure, body weight, level of blood cholesterol, and 24hour ambulatory blood pressure. The post-experimental Cronbach's Alpha as the reliability test of scales were 0.703-0.897, an appropriate level of confidence. The effect of the program was analyzed by experimental stages ; the first week, the fifth week, and the ninth week since the experimental imput began. Data were analyzed by the SPSS PC+ program with paired t-test and t-test, repeated measure ANOVA, and pearson's correlation to de termine the effect of program. The results were as follows : 1) After the self-regulation program, scores on knowledge(t=-2.41, p=.011), perceived self-efficacy (F=5.60, p=.001), self-care performance(F=22.31, p=.0001) were significantly higher than those before the program. 2) After the program, both systolic and diastolic blood pressure were significantly lower than those before the program(F=10.89 -13.11, p=.0001). However in 24hour ambulatory blood pressure, systolic mean pressure was nearly significantly lower, but not in diastolic mean pressure. 3) After the program, the body weight was significant decresed(t=5.53, p=.0001), but the blood cholesterol level was not decreased significantly except in those cases with higher cholesterol level. 4) There were significant relationships between changes in self-care performance and diastolic pressure at 1st week (r=.3389, p=.033) and changes in self-care performance and systolic pressure at 9th week(r=.3651, p=.024). 5) There were significant relationship between perceived self-efficacy and self-care performance at 5th week(r=.5313, p=.001) and 9th week (r=.3026, p=.052). 6) After the program, internal health locus of control and perceived benefits did not show significant change, but perceived barriers was significantly lower than those before the program (t=3.57, p=.0001). From the above results, it can be concluded that 1) The self-regulation program is an effective nursing strategy to promote self-care performance of hypertensives and to lower the blood pressure. Thus this program can be recommended in the management of the hypertensives in workplaces and community settings. 2) The synthesis of Orem's self-care theory and Bandura's self-regulation & self-efficacy theory in this study was proved to enhance explanation and prediction of the change of self-care behavior. Thus the result of the study would contribute in development of the self-care theory and an expansion of practice-theory.

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An Effect of Aquatic Exercise Program with Self-help Group Activites and Strategies for Promoting Self-efficacy on Pain, Physiological Parameters and Quality of Life in Patients having Rheumatoid Arthritis. (자조집단 활동과 자기효능성 증진법을 이용한 수중운동 프로그램이 류마티스 관절염 환자의 통증, 생리적 지수 및 삶의 질에 미치는 영향)

  • Kim, Jong-Im
    • Journal of muscle and joint health
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    • v.1 no.1
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    • pp.1-30
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    • 1994
  • Rheumatoid arthritis is a chronic systematic disease with unpredictable course of exacerbation and remission, characterized by pain, joint deformity and reduced activity by joint limitation. The growing public awareness of the need for health management of chronic illnesses, provides impetus for nursing to demonstrate social effectiveness by active nursing intervention in this vast area in general, and with rheumatoid condition in particular. However, nursing interventions to date have not demonstrated its active participation in the management of chronic conditions. Nursing intervention for the patients having rheumatoid arthritis is one such area that needs to be studied intensively and to demonstrate their effectiveness empirically. The purposes of this study were two fold : first, to develop a comprehensive program that was intensified with therapeutic joint exercises in water, self-help group activities and utilization of self-efficacy promoting strategies : and secondly, to determine the effect of aquatic exercise program on pain, physiological changes and quality of life in the rheumatoid arthritis patients. Thirty five female subjects participating in this study were selected from outpatients in the Rheumatism Center, Hanyang University hospital. The period of data collection was from December, 1992 to March, 1993 in seoul and Taejeon. Subjects in Taejeon were assigned to the experimental group. The comprehensive aquatic exercise program for the experimental group was carried out three times a week for 6 weeks in regular swimming pool. Subjects in Seoul did not participated in the program, and treated as the control group. Data were analyzed with repeated measure MANCOVA, t-test, ANCOVA, percentage of change, Kruskal-Wallis 1-Way ANOVA using SPSS $PC^+$ program. Results were obtained as follows : 1) Scores on Korean pain scale, Numeric pain score, and RAI score of the experimental group were significantly lower than those of the control group (t=2.11, p=0.022 ; F=4.40, p=0.044 : t=3.10, p=0.002). 2) There was significant improvement in the physiological parameters (higher joint movement parameters, F=15.64, p=0.024 ; higher lean body mass, percentage of change=+12.2, lower body weight, t=1.01, p=0.026 : lower ESR, t=1.69, p=0.001) in the experimental group compaired with subjects In the control group. 3) There was significant improvement in the specific self-efficacy score through the comprehensive aquatic exercise program(t=2.73, p=0.011), but not in the general self- efficacy score(t=0.62, p=0.113). 4) The quality of life failed to show significant improvement in the experimental group as compaired with the control group (F=3.69, p=0.064). 5) In the experimental group, findings from additional analysis showed no significant difference in the specific self-efficacy between those who continued to aquatic exercise after completing 6 week program and those who stopped (X2=0.086, p=0.690). Therefore, adherence to aquatic exercise program for 6 weeks seem to be affected mainly by self-help group activities. An indepth study to delve into articulation of mechanisms affecting the effect of aquatic exercise program be recommended. A further study is necessary to determine the difference in the effect of group and individual aquatic exercise program, to assess factors affecting adherence to exercise for an extended length of time.

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Evaluation of nutritional status and adequacy of energy and nutrient intakes among atopic dermatitis children under 12 years of age: based on Korea National Health and Nutrition Examination Survey data (2013-2015) (12세 미만 아토피 피부염 어린이의 에너지 및 영양소적정섭취 수준 평가: 2013-2015년 국민건강영양조사 자료를 바탕으로)

  • Kim, Hye Won;Kim, Ji-Myung
    • Journal of Nutrition and Health
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    • v.53 no.2
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    • pp.141-154
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    • 2020
  • Purpose: Atopic dermatitis (AD), a typical chronic disease in children, is an allergy disease that is highly associated with food. Thus, attention to food intake is needed to prevent and manage it. Therefore, we analyzed differences in food and nutrient intakes depending on AD status in under 12-year-old children. Methods: A total of 2,690 participants were enrolled in this study from the combined 2013-2015 Korea National Health and Nutrition Examination Survey. Subjects were divided into an AD group and normal group (non-AD group). General characteristic, food and nutrients intakes, and prevalence of insufficient and excessive nutrient intake were analyzed using χ2 test and regression analyses. The AD odds ratio (OR) for insufficient and excessive nutrient intakes was analyzed using multiple logistic regression analyses. Results: Food and nutrient intakes were not significantly different between the AD and non-AD groups. However, the ratio of calcium intake to recommended nutrient intake was about 70% in both groups, which can be attributed to the overall lack of calcium intake among Korean children. There were no differences in energy or nutrient intakes between the groups, but compared with Korean Dietary Reference Intakes for Koreans, the appropriate intake ratios of fat and vitamin C in the AD group were higher than those in the non-AD group. The AD OR decreased when fat was consumed at above appropriate levels and vitamin C was consumed at lower or excess levels. Conclusion: In children, AD may be related to the nutrient intake ratio of fats and vitamin C, and we speculate that these results were affected by dietary restrictions for AD management.

Serum Vitamin D Status in Iranian Fibromyalgia Patients: according to the Symptom Severity and Illness Invalidation

  • Maafi, Alireza Amir;Ghavidel-Parsa, Banafsheh;Haghdoost, Afrooz;Aarabi, Yasaman;Hajiabbasi, Asghar;Masooleh, Irandokht Shenavar;Zayeni, Habib;Ghalebaghi, Babak;Hassankhani, Amir;Bidari, Ali
    • The Korean Journal of Pain
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    • v.29 no.3
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    • pp.172-178
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    • 2016
  • Background: This study was designed to assess serum vitamin D status (25-OHD) in the fibromyalgia (FM) patients and to compare it with a healthy control group. It also aimed to investigate the correlation of serum vitamin D level with FM symptom severity and invalidation experiences. Methods: A total of 74 consecutive patients with FM and 68 healthy control participants were enrolled. The eligible FM patients completed the Illness Invalidation Inventory (3*I), the Revised Fibromyalgia Impact Questionnaire (FIQR) and a short-form health survey (SF-12). Venous blood samples were drawn from all participants to evaluate serum 25-OHD levels. Mann-Whitney tests and multiple logistic regression analyses were performed and Spearman's correlations were calculated. Results: 88.4% of FM patients had low levels of serum 25-OHD. FM patients had significantly higher level of serum 25-OHD than the control group ($17.24{\pm}13.50$ and $9.91{\pm}6.47$ respectively, P = 0.0001). There were no significant correlations between serum 25-OHD levels and the clinical measures of disease impact, invalidation dimensions, and health status. Multiple logistic regression analyses revealed that an increased discounting of the disease by the patient's spouse was associated with a 4-fold increased risk for vitamin D deficiency (OR = 4.36; 95% CI, 0.95-19.87, P = 0.05). Conclusions: This study showed that although high rates of vitamin D insufficiency or deficiency were seen among FM patients and healthy non-FM participants, but it seems there was no intrinsic association between FM and vitamin D deficiency. Addressing of invalidation experience especially by the patient's spouse is important in management of FM.

The Survival Rate of Korean Patients with COPD with or without Acute Exacerbations

  • Uh, Soo-Taek;Lee, Ji-Yeon;Koo, So-Mi;Kim, Yang-Ki;Kim, Ki-Up;Park, Jong-Sook;Park, Sung-Woo;Jang, An-Soo;Kim, Do-Jin;Choi, Jae-Sung;Na, Joo-Ok;Suh, Ki-Hyun;Kim, Yong-Hoon;Park, Choon-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.70 no.6
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    • pp.474-481
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    • 2011
  • Background: Chronic obstructive pulmonary disease (COPD) is characterized by air low limitation, which is one of the leading causes of mortality worldwide. There have been many studies on survival rates in the world literature, but there have been few reports regarding the survival rate in Korean patients with COPD. Acute exacerbation is regarded as a risk factor for mortality in patients with COPD. The purpose of this study was to investigate the survival rate and the effect of acute exacerbations on the survival rate of Korean patients with COPD. Methods: A total of 502 COPD patients who were diagnosed on the basis of history and lung function tests were enrolled in this study. The frequency of acute exacerbations, body mass index (BMI), C-reactive protein (CRP) and pulmonary hypertension were analyzed. Results: The 3- and 5-year survival rates were 98% and 83%, respectively. The median survival time was 78 months. The median survival time was 55 months in 322 patients with one or more acute exacerbations. The 3- and 5-year survival rates were significantly lower in the 322 patients with one or more acute exacerbations than in those without any. The mortality rate was significantly higher in patients with CRP>3 mg/L than in those with CRP ${\leq}3$ mg/L (p<0.005); it was significantly higher in patients with pulmonary hypertension than in those without it (p<0.01). Conclusion: Because the 5-year survival rate is 83% in Korean patients with COPD, the management of stable patients with COPD should focus on the prevention of acute exacerbations.

Complications and Carcinogenic Effects of Mustard Gas - a Systematic Review and Meta-Analysis in Iran

  • Panahi, Yunes;Gholami, Nasrin;Ghojazadeh, Morteza;Moslemi, Farnaz;Naghavi-Behzad, Mohammad;Azami-Aghdash, Saber;Ghaffari, Alireza;Piri, Reza
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.17
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    • pp.7567-7573
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    • 2015
  • Background: Catastrophic effects of mustard gas as a chemical warfare agent have always been a major problem for those exposed to this agent. In this meta-analysis it was tried to evaluate carcinogenesis, ocular, cutaneous and respiratory complications of mustard gas exposure among Iranians who had been exposed to this agent during the Iran-Iraq war. Materials and Methods: In this meta-analysis, the required data were collected using keywords "mustard gas", "sulfur mustard", "cancer", "neoplasm", "respiratory complications", "ocular complications", "lung disease", "chronic complication", "eye", "skin", "cutaneous complication", "carcinogenesis" and their combination with keywords "Iran", "Iranian", "prevalence", "mortality" and their Farsi equivalent terms from the databases of SID, Iranmedex, Magiran, Pubmed, Science Direct, Google Search engine, Gray Literature and Reference of References. To determine the prevalence of each complication and perform meta-analysis, CMA: 2 (Comprehensive Meta-Analysis) software with a randomized model was used. Results: Of the 542 articles found, 7 national articles, consistent with the aims of this study were selected. Meta-analysis of seven papers revealed that cancer risk, especially cancer of the respiratory system was elevated, so that the relative risk (RR) of cancer role of mustard gas was inconsistent from 2/1 to 4 in this survey. Also prevalence of delayed skin disorders due to sulfur mustard was 94.6%, pulmonary complications 94.5% and ocular complications 89.9%. The incidence of various cancers in victims exposed to mustard gas was 1.7% worldwide where the rate was 2.2% in Iranian victims of the Iraq-Iran war. Conclusions: Based on present study the prevalence of delayed mustard gas related cutaneous, pulmonary and ocular complications is above 90% and risk of carcinogenesis is higher in comparison to worldwide statistics. This may suggest need for long-term and persistent follow-up and rehabilitation procedures for populations exposed to this agent.

A Comparative Study on Health Promotion Behaviors by Complementary Alternative Therapy Utilization of Elderly Women with Osteoarthritis (퇴행성관절염 여성노인들의 보완대체요법 이용 유무에 따른 건강증진행위 비교)

  • Kim, Jeong-Suk;Park, Jeong-Sook
    • Journal of Digital Convergence
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    • v.16 no.2
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    • pp.451-459
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    • 2018
  • The aim of this study is to compare the differences in health promotion behaviors by the use of complementary alternative therapy(CAT) in elderly women with osteoarthritis. A total of 621 elderly women with osteoarthritis from public health centers and their branches at a city of C state were enrolled. This study analyzed the frequency and percentage of complementary alternative therapy utilization; a Chi-square test was used for utilization analysis according to subjects' general characteristics and disease features. Degree of health promotion behaviors according to CAT utilization was analyzed by a t-test and ANOVA. The study found that the CAT utilization rate for the total of 621 people was 61.7 %. For health promotion behaviors according to CAT utilization, statistically significant differences were found in exercise (p<0.001), health responsibility (p<0.001) and self-realization (p=0.016) from the domains. This study demonstrated the differences of health promotion behaviors based on CAT utilization. Due to the results of this study it is notable to mention that counseling, instruction for CAT utilization, and strategy development for health promotion are necessary for elderly women with osteoarthritis.

The correlation analysis between fatigue and health promoting life style among a rural college students (일 지역 대학생의 피로와 건강증진 생활양식과의 관계분석)

  • Jang Hee-Jung
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.6 no.3
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    • pp.477-492
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    • 1999
  • The disease patterns among the Korean was shifted from acute and infectious diseases to chronic diseases. According to the these disease patterns trends, people have concerned about the health promotion and health behaviors. Pender's(1996) revised health promotion model(HPM) is consist of three categories; Individual characteristics and experiences, Behavior-specific cognitions and affect, behavioral outcome. Of these categories, individual characteristics and experiences, this category of variables is considered to be of biological, psychological and socio-cultural personal factors, especially, individual fatigue. Futhermore. these variables constitute a critical core for nursing intervention, as they are subject to modification through nursing actions. But there is no few the research of the relationship between the fatigue and health promotion. Therefore, the purpose of this study is to investigate the correlation between the fatigue and health promoting life style among a rural college students. Additionally, this descriptive correlational study identified the relation of demographic factors and fatigue, health promoting life style. From June 20 to 26, 1998, a convenience sample of 270 college students completed the questionnaire of the fatigue and health promoting life style profile which were developed by the Yoshitake(1978) and Walker, et al.(1987), respectively. The descriptive correlational statistics, mean, t-test, ANONA, Pearson correlation coefficient were used to analyze the data gathered with SAS pc+ program. The results were as it follows: 1. The average fatigue score of the subjects was $64.93{\pm}12.89$. Fatigue scores by subcategory were physical symptoms($23.5{\pm}4.87$). psychological symptoms($22.11{\pm}4.66$) and neuro-sensory symptoms($19.32{\pm}5.14$). With the respect to the demographic characteristics of the subjects, there were statistically significant differences between the demographic factors and fatigue, especially, sex(t==3.69 p<0.01), major(t=-2.89 p<0.01). the experience of family illness(t=2.76 p<0.01). 2. The average health promoting life style item score of the subjects was $2.33{\pm}0.33$. In the subcategories, the highest degree of performance was self-actualization(2.94), following interpersonal support(2.81). stress management(2.33), exercise(2.20), nutrition(2.10), and the lowest degree was health responsibility(1.73). There were the significant differences on the learning of health education(t=2.00 p<0.01). religion(F=3.01, p<0.05), circle activity(t=2.07, p<0.05), nutrition control(t=5.25, p<0.01) of demographical factors with the health promoting life style. 3. The correlation between the fatigue and health promoting life style made statistically no significance(r=-0.09731, p>0.05). But there was negative significant relationship between health promoting life style and psychological symptom as a fatigue subcategory(r=-0.15721, p<0.05). The self-actualization showed negative significant correlation with all fatigue subcategory. The health responsibility showed significant relationship with total fatigue(r=0.13050. p<0.05). For further research, it suggests to replicate the correlational and causal study between the fatigue and the health promoting life style using the another fatigue scale which is able to measure the subjective and objective fatigue degree. And it needs to develop the nursing intervention program for maintaining and promoting the health behavior as well as for decreasing the college students's fatigue.

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Sleep-Related Respiratory Disturbances (수면과 관련된 호흡장애)

  • Moon, Hwa-Sik
    • Sleep Medicine and Psychophysiology
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    • v.2 no.1
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    • pp.55-64
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    • 1995
  • During sleep, relatively major respiratory physiological changes occur in healthy subjects. The contributions and interactions of voluntary and metabolic breathing control systems during waking and sleep are quite different Alterations of ventilatory control occur in chemosensitivity, response to mechanical loads, and stability of ventilation. The activities of intercostal muscles and muscles involved in regulating upper airway size are decreased during sleep. These respiratory physiological changes during sleep compromise the nocturnal ventilatory function, and sleep is an important physiological cause of the nocturnal alveolar hypoventilation. There are several causes of chronic alveolar hypoventilation including cardiopulmonary, neuromuscular diseases. Obstructive sleep apnea syndrome (OSAS) is an important cause of nocturnal hypoventilation and hypoxia. Coexistent cardiopulmonary or neuromuscular disease in patients with OSAS contributes to the development of diurnal alveolar hypoventilation, diurnal hypoxia and hypercapnia. The existing data indicates that nocturnal recurrent hypoxia and fragmentation of sleep in patients with OSAS contributes to the development of systemic hypertension and cardiac bradytachyarrhythmia, and diurnal pulmonary hypertension and cor pulmonale in patients with OSAS is usually present in patients with coexisting cardiac or pulmonary disease. Recent studies reported that untreated patients with OSAS had high long-term mortality rates, cardiovascular complications of OSAS had a major effect on mortality, and effective management of OSAS significantly decreased mortality.

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Beck Depression Inventory Score and Associated Factors in Korean Patients with Lumbar Spinal Stenosis (척주관협착증 환자의 Beck Depression Inventory 점수와 이와 관련된 요인들의 분석)

  • Kim, Ae Ra;Seo, Bo Byoung;Kim, Jin Mo;Bae, Jung In;Jang, Young Ho;Lee, Yong Cheol;Kang, Chul Hyung;Jung, Sung Won;Hong, Ji Hee
    • The Korean Journal of Pain
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    • v.20 no.2
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    • pp.138-142
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    • 2007
  • Background: Depression is a frequent comorbid disease of chronic pain patients. This study was conducted to evaluate the prevalence of depression and to correlate associated factors and depression in patients with lumbar spinal stenosis. Methods: The data of this survey was collected from 97 patients that visited our pain clinic for the management of lumbar spinal stenosis. Depression was examined by a self-reported survey using the Korean version of the Beck Depression Inventory (BDI). The Oswestry Disability Index (ODI) and the life satisfaction scale score were also obtained. Demographic and clinical characteristics (including spouse status, employment status, smoking status, the number of patients with multiple painful areas, the number of patients with combined disease, pain duration, visual analogue scale, Roland 5-point scale and walking distance) were obtained from an interview with the patient. The patients were divided into group N ($BDI{\leq}14$, n = 43) and group 0 (BDI > 14, n = 54) according to the BDI scale. Of the 97 patients, 55,7% had a high BDI score. Results: The patients in group N had a higher rate of employment (48.0%, P < 0.05) and had higher life satisfaction scale scores ($9.4{\pm}2.5$, P < 0.01) as compared to group D patients. The BDI score showed a close correlation with employment status and the life satisfaction scale. Conclusions: Many lumbar spinal stenosis patients had high BDI scores. Employment status and the life satisfaction scale were closely correlated with the BDI score.