Myunghan Choi

Identifying and treating the culture‐bound syndrome of Hwa‐Byung among older Korean immigrant women: Recommendations for practitioners

Purpose: To introduce advanced practice nurses to the concept of Hwa-Byung, a culture bound syndrome that is now accepted as a psychiatric term. Data sources: Information from the Diagnostic and Statistical Manual and selected research and clinical articles. Conclusions: Hwa-Byung is a culture-bound syndrome caused by long-standing suppressed anger prevalent among older immigrant women of Korean heritage. Although the concept of Hwa-Byung was reported more than a decade ago, it has not been studied cross-culturally nor described sufficiently in the literature. Implications for practice: The use of appropriate guidelines and an understanding of Hwa-Byung is essential for proper assessment, diagnosis (especially to distinguish it from clinical depression), and culturally sensitive management of this condition. Korean versions of screening tools are provided as online supporting information.Purpose: To introduce advanced practice nurses to the concept of Hwa‐Byung, a culture bound syndrome that is now accepted as a psychiatric term. Data sources: Information from the Diagnostic and Statistical Manual and selected research and clinical articles. Conclusions: Hwa‐Byung is a culture‐bound syndrome caused by long‐standing suppressed anger prevalent among older immigrant women of Korean heritage. Although the concept of Hwa‐Byung was reported more than a decade ago, it has not been studied cross‐culturally nor described sufficiently in the literature. Implications for practice: The use of appropriate guidelines and an understanding of Hwa‐Byung is essential for proper assessment, diagnosis (especially to distinguish it from clinical depression), and culturally sensitive management of this condition. Korean versions of screening tools are provided as online supporting information.

One-Hour Glucose During an Oral Glucose Challenge Prospectively Predicts β-Cell Deterioration and Prediabetes in Obese Hispanic Youth

OBJECTIVE In adults, 1-h glucose during an oral glucose tolerance test (OGTT) predicts the development of type 2 diabetes independent of fasting and 2-h glucose concentrations. The purpose of the current investigation was to examine the utility of elevated 1-h glucose levels to prospectively predict deterioration in β-cell function and the development of prediabetes in high-risk youth. RESEARCH DESIGN AND METHODS Obese Latino youth with a family history of type 2 diabetes (133 male and 100 female; age 11.1 ± 1.7 years) completed a baseline OGTT and were divided into two groups based upon a 1-h glucose threshold of 155 mg/dL (<155 mg/dL, n = 151, or ≥155 mg/dL, n = 82). Youth were followed annually for up to 8 years for assessment of glucose tolerance, body composition by dual-energy X-ray absorptiometry, and insulin sensitivity, insulin secretion, and the disposition index by the frequently sampled intravenous glucose tolerance test. RESULTS Over time, the ≥155 mg/dL group exhibited a significantly greater decline in β-cell function compared with youth with a 1-h glucose <155 mg/dL (β = −327.8 ± 126.2, P = 0.01). Moreover, this decline was independent of fasting or 2-h glucose and body composition. When the data were restricted to only participants with normal glucose tolerance at baseline, a 1-h glucose ≥155 mg/dL was independently associated with a 2.5 times greater likelihood of developing prediabetes during follow-up (95% CI 1.6–4.1, P = 0.0001). CONCLUSIONS These data suggest that a 1-h glucose ≥155 mg/dL during an OGTT is an independent predictor of β-cell deterioration and progression to prediabetes among obese Latino youth.

Spanish Translation and Cross-Language Validation of a Sleep Habits Questionnaire for Use in Clinical and Research Settings

STUDY OBJECTIVES To translate, back-translate and cross-language validate (English/Spanish) the Sleep Heart Health Study Sleep Habits Questionnaire for use with Spanish-speakers in clinical and research settings. METHODS Following rigorous translation and back-translation, this cross-sectional cross-language validation study recruited bilingual participants from academic, clinic, and community-based settings (N = 50; 52% women; mean age 38.8 ± 12 years; 90% of Mexican heritage). Participants completed English and Spanish versions of the Sleep Habits Questionnaire, the Epworth Sleepiness Scale, and the Acculturation Rating Scale for Mexican Americans II one week apart in randomized order. Psychometric properties were assessed, including internal consistency, convergent validity, scale equivalence, language version intercorrelations, and exploratory factor analysis using PASW (Version18) software. Grade level readability of the sleep measure was evaluated. RESULTS All sleep categories (duration, snoring, apnea, insomnia symptoms, other sleep symptoms, sleep disruptors, restless legs syndrome) showed Cronbach α, Spearman-Brown coefficients and intercorrelations ≥ 0.700, suggesting robust internal consistency, correlation, and agreement between language versions. The Epworth correlated significantly with snoring, apnea, sleep symptoms, restless legs, and sleep disruptors) on both versions, supporting convergent validity. Items loaded on 4 factors accounted for 68% and 67% of the variance on the English and Spanish versions, respectively. CONCLUSIONS The Spanish-language Sleep Habits Questionnaire demonstrates conceptual and content equivalency. It has appropriate measurement properties and should be useful for assessing sleep health in community-based clinics and intervention studies among Spanish-speaking Mexican Americans. Both language versions showed readability at the fifth grade level. Further testing is needed with larger samples.

Construct validity of the Korean women's abuse intolerance scale

Background: Domestic violence against married women has persisted throughout Korean history. However, very little empirical research has been conducted in Korea about domestic violence, its causes, or womens responses. Objective: To develop and test psychometrically the Korean Womens Abuse Intolerance Scale (KWAIS) to measure womens propensity or desire to leave abusive husbands in Korea. Methods: The first phase of the investigation involved qualitative research to explore the themes of womens responses to domestic violence and the development of the instrument. The second phase was a preliminary study conducted to examine womens responses to domestic violence. In the third phase, construct validity of the scale was established, using a sample of 184 married women living in Korea. Results: The KWAIS adequately supported the underlying theory of womens responses to domestic violence, demonstrating strong content validity, high internal consistency (Cronbachs &agr; of .98), and criterion-related validity evidenced by significant correlations that supported hypotheses among abuse intolerance and abuse (r = .69), traditional family ideology (r = −.78), marital satisfaction (r = −.85), attitude toward power ascription (r = .63), and collectivism (r = −.88). Factor analysis yielded a four-factor structure, explaining 78.4% of the common variance. Factor loadings ranged from .65 to .93. Discussion: The findings for the psychometric properties of the KWAIS established its potential as a research instrument in measuring Korean womens propensity or desire to leave abusive husbands. Future studies need to focus on determining the predictive validity of the KWAIS and evaluating cross-cultural differences in womens propensity or desire to leave abusive husbands.

Psychometric Evaluation of the Index of Self-Regulation

Index of Self-Regulation (ISR) is a nine-item scale designed primarily to measure individuals’ level of self-regulation for physical activity. The aim of this study is to report psychometric characteristics of the ISR. The ISR scale was administered in a sample of 183 adult patients at 2 weeks following graduation from cardiac rehabilitation, 3 months following graduation, and 6 months following graduation. The internal consistency of the ISR was high at all three time points, with Cronbach’s alphas of .81 to .96 across time points. The test—retest reliability was fairly high, with an overall coefficient of .73. There was evidence of concurrent validity of the ISR based on its moderately significant correlations with other theoretically relevant variables, including self-knowledge and motivational appraisal for physical activity. In conclusion, the ISR is a reliable and valid measure to assess the level of self-regulation in the maintenance of physical activity.

Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population

Changes in distribution policies have increased median MELD at transplant with recipients requiring increasing intensive care perioperatively. We aimed to evaluate association of preoperative variables with postoperative respiratory failure (PRF)/increased intensive care unit length of stay (ICU LOS)/short-term survival in a high MELD cohort undergoing liver transplant (LT). Retrospective analysis identified cases of PRF and increased ICU LOS with recipient, donor, and surgical variables examined. Variables were entered into regression with end points of PRF and ICU LOS > 3 days. 164 recipients were examined: 41 (25.0%) experienced PRF and 74 (45.1%) prolonged ICU LOS. Significant predictors of PRF with univariate analysis: BMI > 30, pretransplant MELD, preoperative respiratory failure, LVEF < 50%, FVC < 80%, intraoperative transfusion > 6 units, warm ischemic time > 4 minutes, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted PRF (OR 1.14, p = 0.01). Significant predictors of prolonged ICU LOS with univariate analysis are as follows: pretransplant MELD, FVC < 80%, FEV1 < 80%, deceased donor, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted prolonged ICU LOS (OR 1.28, p < 0.001). One-year survival among cohorts with PRF and increased ICU LOS was similar to subjects without. Pretransplant MELD is a robust predictor of PRF and ICU LOS. Higher MELDs at LT are expected to increase need for ICU utilization and modify expectations for recovery in the immediate postoperative period.

A socioecological predication model of posttraumatic stress disorder in low-income, high-risk prenatal Native Hawaiian/Pacific Islander women

INTRODUCTION Only recently has perinatal posttraumatic stress disorder (PTSD) been researched in any depth; however, the causes and consequences of this serious illness remain unclear. Most commonly, childbirth trauma and interpersonal violence have been reported as contributing factors. However, not all Native Hawaiian/Pacific Islander (NHPI) women who experience these events experience PTSD. The factors affecting PTSD are many and complex, intertwining individual, family, and community contexts. Using a socioecological framework, 3 levels of contextual variables were incorporated in this study (individual, family, and social/community). The purpose of this study was to determine the socioecological predictors associated with prenatal PTSD among NHPI. METHODS A case-control design was used to collect retrospective data about socioecological variables from medical record data. The sample was low-income, high-risk NHPI women receiving perinatal health care at a rural community health center in Hawaii who screened positive (n = 55) or negative (n = 91) for PTSD. RESULTS Hierarchical logistic regression was conducted to determine socioecological predictors of positive PTSD screening. Although the majority of women (66.4%) experienced some form of interpersonal violence, a constellation of significant predictor variables from all 3 levels of the model were identified: depression (individual level), lack of family support and family stress (family level), and violence (social/community level). DISCUSSION Each of the predictor variables has been identified by other researchers as significantly affecting perinatal PTSD. However, it is because these variables occur together that a more complex picture emerges, suggesting the importance of considering multiple variables in context when identifying and caring for these women. Although additional research is needed, it is possible that the significant predictor variables could be useful in identifying women who are at higher risk for PTSD in other similar populations.

Management of venous thromboembolism for older adults in long‐term care facilities

Purpose: To provide information on current evidence‐based clinical management of venous thromboembolism (VTE) for nurse practitioners working for older adults in long‐term care facilities. Methods and data resources: A systematic review and summary using current clinical guidelines and reliable clinical research studies: American Medical Directors Association, American College of Chest Physicians, Medline, PubMed, Refworks, and CINAHL. Conclusions: The management of VTE focuses on a comprehensive approach including acute and long‐term pharmacologic approach, surgical and mechanical approach, prophylaxis of recurrent VTE, maintaining INR, and monitoring lab values. Implications: Recommendations based on the most current clinical research studies and guidelines will facilitate a cost‐effective management of venous thromboembolism for older adults in long‐term care facilities.

25-Vitamin D levels in chronic hepatitis C infection: association with cirrhosis and sustained virologic response

Background Low serum 25-Vitamin D levels are associated with advanced fibrosis in hepatitis C infection. Vitamin D supplementation has been hypothesized to augment response rates to interferon-based therapy. To date, no investigation has evaluated vitamin D levels during direct-acting antiviral therapy. We aimed to evaluate the prevalence of vitamin D deficiency in cirrhotic and non-cirrhotic cohorts, the predictive value of pretreatment levels for a sustained virologic response, and the changes in 25-OH vitamin D levels during direct-acting antiviral therapy. Methods Two hundred eighteen patients with chronic hepatitis C who completed direct-acting antiviral therapy were consecutively enrolled. Vitamin D levels were measured using chemiluminescence immunoassay, prior to initiation and at completion of therapy. Advanced liver fibrosis (cirrhosis) was determined by biopsy, FibroSURE blood test, or imaging. Results A sustained virologic response was achieved in 79% (n=172) of patients, with 19% (n=44) relapsing. A total of 123 (56.4%) patients were cirrhotic. The prevalence of Vitamin D deficiency (10-20 ng/mL) and severe deficiency (<10 ng/mL) was significantly higher in cirrhotic patients (P=0.04). Pre-treatment vitamin D levels in cirrhotic patients were negatively correlated with Model for End-Stage Liver Disease score, total bilirubin and INR (P<0.05). Neither pretreatment vitamin D level nor the change during therapy was associated with an increased rate of sustained virologic response. Conclusions The prevalence of vitamin D deficiency is higher in hepatitis-C–related cirrhotic cohorts compared to non-cirrhotic patients and correlates with components of hepatic function. Neither pretreatment vitamin D level nor the change during therapy was associated with an increased rate of sustained virologic response.

Testing women's propensities to leave their abusive husbands using structural equation modeling

Background:Many Korean women are just beginning to recognize that what they considered to be normal treatment is actually domestic violence. Many are becoming more intolerant of the abuse and more likely to desire to leave an abusive relationship. Objective:The aim of this study was to test, using the framework of sociostructural and psychological-relational power (PRP), a model of Korean womens propensities to leave their abusive husbands. Methods:Multigroup structural equation modeling was used to test relationships between variables chosen from the sociostructural power and PRP to explain intolerance to abuse. Married Korean women (n = 184) who self-identified as being abused physically, psychologically, sexually, or financially participated in the study. Results:The multigroup analysis revealed that the relationship of abuse and Hwa-Byung (a culture-bound syndrome that denotes Korean womens anger) with intolerance was supported for women with low education (defined as having an education of high school or less: ≤12 years); also for this group, particularly among the younger women, high power was related to high levels of reported abuse and abuse intolerance. For women in the high-education group (education beyond high school: ≥13 years), high power was related to abuse, Hwa-Byung, and abuse intolerance; age did not influence power. Overall, the multigroup model adequately fitted the sample data (&khgr;2 = 92.057, degree of freedom = 50, p = .000; normal fit index = .926, comparative fix index = .964, root mean square error of approximation = .068, Hoelters critical number = 152), demonstrating that education is a crucial moderator of Korean womens attitude toward the unacceptability of abuse and propensity to terminate the marriage. Discussion:This study found support for a model of abuse intolerance using the framework of sociostructural power and PRP, primarily for the low-education group. Hwa-Byung was a mediating factor that contributed to intolerance to abuse in women with low education. This study highlights the importance of understanding the cultural assumptions that guide Korean womens beliefs and behaviors about abuse intolerance, suggesting that effective intervention programs should be specific to age and education, including a focus on resource availability, which could clarify the variations in Korean womens responses to abuse intolerance.