Sukhee Ahn

Effects of Tai Chi Exercise on glucose control, neuropathy scores, balance, and quality of life in patients with type 2 diabetes and neuropathy.

PURPOSE The aim of this study was to determine the effects of Tai Chi exercise on glucose control, neuropathy scores, balance, and quality of life in patients with type 2 diabetes and neuropathy. METHODS A pretest-posttest design with a nonequivalent control group was utilized to recruit 59 diabetic patients with neuropathy from an outpatient clinic of a university hospital. A standardized Tai Chi for diabetes program was provided, which comprised 1 hour of Tai Chi per session, twice a week for 12 weeks. Outcome variables were fasting blood glucose and glycosylated hemoglobin for glucose control, the Semmes-Weinstein 10-g monofilament examination scores and total symptom scores for neuropathy, single leg stance for balance, and the Korean version of the SF-36v2 for quality of life. Thirty-nine patients completed the posttest measures after the 12-week Tai Chi intervention, giving a 34% dropout rate. RESULTS The mean age of the participants was 64 years, and they had been diagnosed with type 2 diabetes for more than 12 years. The status was significantly better for the participants in the Tai Chi group (n=20) than for their control (i.e., nonintervention) counterparts (n=19) in terms of total symptom scores, glucose control, balance, and quality of life. CONCLUSION Tai Chi improved glucose control, balance, neuropathic symptoms, and some dimensions of quality of life in diabetic patients with neuropathy. Further studies with larger samples and long-term follow-up are needed to confirm the effects of Tai Chi on the management of diabetic neuropathy, which may have an impact on fall prevention in this population.

Supplementing Relaxation and Music for Pain After Surgery

Background: Most postoperative patients have unrelieved pain despite the use of patient-controlled analgesia. Nurses need additional effective modalities. Relaxation and music (RM), in addition to analgesics, have been shown to reduce pain more than do analgesics alone. Objectives: The objectives of the study were to test an intervention of patient teaching for pain management (PT) and compare it with RM for immediate and general effects on postoperative pain. Methods: Patients having abdominal surgery and receiving patient-controlled analgesia aged 18-75 years (n = 517) were randomized to four groups: PT, RM, a combination (PTRM), and a control. A 2 × 2 factorial design was used to assess PT-Effects and RM-Effects. Immediate effects on pain were measured on visual analogue sensation and distress scales before and after five 20-min tests in the first 2 days. Because participants also listened independently, general nonimmediate effects were examined at eight other times. Results: Using multivariate analysis of covariance with contrasts and pretest control, immediate RM-Effects on pain were found at Day 1 a.m. (p < .001), Day 1 p.m. (p = .04), and Day 2 a.m. (p = .04). No PT-Effects or nonimmediate RM-Effects were found. Discussion: Patient teaching did not result in less pain and did not support the theoretical proposition that PT reduces pain. However, the immediate RM-Effects supported the proposition that nonpharmacological adjuvants to analgesics can ease pain without adding side effects.

Factors explaining quality of life in individuals with coronary artery disease

PURPOSE The study was done to compare quality of life by gender, and to identify factors which explain quality of life in individuals with coronary artery disease. METHODS For the survey, 91 individuals (53 men and 38 women) agreed to participate in the study. Cardiovascular risk factors, systolic blood pressure, body mass index, total cholesterol, triglyceride, high density lipoprotein-cholesterol, and low density lipoprotein-cholesterol, health behavior as well as quality of life, were measured. Descriptive statistics, t-test, correlation and hierarchical multiple regression with SPSS WIN 12.0 were used to analyze the data. RESULTS Significant gender differences were found for education, smoking status, chronic disease, perceived health status, and quality of life within sub-dimensions. Hierarchical regression analysis showed gender (men), age, perceived health status, cardiovascular risk scores, and health behaviors together explained 40.2% (adjusted R2) of variance in quality of life. CONCLUSION As the factors explaining quality of life in individuals with coronary artery disease have been identified as gender (men), age, perceived health status, and health behaviors, health promotion programs designed for this population should focus on these factors for effective behavioral modification, and consequent improvement in quality of life.

Korean and American Music Reduces Pain in Korean Women After Gynecologic Surgery

American music has been found to relieve pain in adults in several countries but has not been tested in Korea. Korean women have reported that they would like American music as well as Korean folk songs and religious music sung in Korean. The study purpose was to pilot-test the effects of music on pain after gynecologic surgery in Korean women and to compare pain relief between those who chose American or Korean music. Using a quasiexperimental pretest-posttest design, 73 South Korean women on a preoperative unit were assigned by day of the week to receive music (n = 34; 47%) or no music (n = 39; 53%). The music group chose among Korean (ballads and religious and popular songs) and American (soft slow piano and orchestra) music and heard it for 15 minutes at four time points (postoperatively), whereas the controls rested in bed. They marked VAS Sensation and Distress of Pain scales before and after each test. The two groups were similar on pretest pain. When controlling for pretest pain, MANCOVA indicated that there was significantly less posttest pain in those with music plus analgesics than those with analgesics alone at three of the four tests: p = .04 to .001. Two-thirds in the music group (n = 21; 62%) chose Korean music and one-third (n = 13; 38%) chose American, with no difference in pain: both were effective. In addition to analgesics, music can be used to reduce postoperative pain in Korean women. Patients selected music that was appealing to them. Nurses in many countries can consider music of the country and seek individual preferences to use in addition to analgesics for postoperative pain.

Effects of Tai Chi Exercise on Cardiovascular Risk Factors and Quality of Life in Post-menopausal Women

PURPOSE Natural menopause resulting in the decline in endogenous estrogen concentrations is responsible for an increased risk of coronary heart disease in postmenopausal women. The purpose of the study was to examine the effects of a 6-month Tai Chi exercise program on cardiovascular risk factors and quality of life in post-menopausal women. METHODS A quasi-experimental design with pretest and posttest measures was used. The participants in the study, 29 women in the Tai Chi group and 31 in the control group, were enrolled for 6 months. RESULTS After 6 months of Tai Chi exercise, total cholesterol (M=213 to 185), LDL-cholesterol (M=135 to 128), and their 10 yr cardiovascular disease risk (M=2.62 to 2.27) had improved significantly for the Tai Chi participants compared to the control group. Total scores for quality of life along with the sub-dimensions of health perception and mental functioning were also significantly higher in the Tai Chi participants. CONCLUSION Tai Chi exercise favorably affected cardiovascular health and quality of life in post-menopausal women after 6 months. Additional rigorous studies are needed to examine long term effects on the prevention of cardiovascular disease in this population.

Predictors of Women's Postpartum Health Status in the First 3 Months After Childbirth

PURPOSE The purpose of this study was to examine the significant predictors of postpartum health indicated by physical health, mental health, and role performance during the first 3 months postpartum. METHODS This study used a correlational survey design. The study subjects were 152 mothers at 6 weeks postpartum (T1) and 131 mothers at 3 months postpartum (T2). At 6 weeks and 3 months postpartum, subjects completed a packet of instruments-measuring physical and mental health, role performance, sense of mastery, social support, and infant temperament. RESULTS Findings indicated that lower family income, more difficult infant temperament, and lower sense of mastery were consistently significant predictors of poorer health outcomes during the postpartum period. Having preterm infants and caring for them was related to higher levels of maternal fatigue in the morning at 6 weeks. Employment did not influence postpartum health. CONCLUSION The findings suggest that mother and infants individual factors and environmental context may continue to negatively affect the mothers health outcomes during the postpartum period.

The association between breastfeeding, the stress response, inflammation, and postpartum depression during the postpartum period: Prospective cohort study

BACKGROUND Research suggests that exclusive breastfeeding may have a stress-protective role in postpartum depression; however, less is known about the underlying mechanisms by which this protection may occur or whether the protective relationship holds for women who mix breast and bottle feeding. OBJECTIVES To examine patterns of the stress response, inflammation, and depressive symptoms among women predominantly breastfeeding or bottle feeding their infants at 6 months postpartum. DESIGN A part of a larger longitudinal study across 6 months postpartum investigating the psychoneuroimmunology (PNI) of postpartum depression. SETTING Prenatal clinics and community. PARTICIPANTS One hundred nineteen postpartum women who met inclusion/exclusion criteria and followed up from the prenatal period to postpartum 6 months. METHODS Data were collected during seven home visits occurring during the 3rd trimester (weeks 32-36) and on postpartum days 7 and 14, months 1, 2, 3, and 6. Women completed stress and depression surveys and provided blood for pro- (IL-1β, IL-6, IL-8, TNF-a, IFN-γ) and anti-inflammatory (IL-10) cytokines, and collected saliva for diurnal cortisol. RESULTS Self-report of predominant breastfeeding during 6 months postpartum ranged from 91.9% at day 7 to 70.6% at month 6 postpartum. There were no associations between the pattern of feeding and depressive symptoms. Biological differences, however, existed between the groups, with levels of salivary cortisol at 8 AM and 8:30 AM at month 6 higher and levels of IL-6 at month 6 lower in women who primarily breastfed compared to those who primarily bottle fed their infants after controlling for confounding variables. CONCLUSIONS Breastfeeding was not related to postpartum depression however differences in stress and inflammatory markers are apparent at month 6 postpartum.

Depression of Married and Employed Women Based on Social-Role Theory

PURPOSE This study was based on social-role theory, and purposes were to investigate (1) how depression and health determinants vary with married and employed women, and (2) what factors contribute to depression according to family cycle. METHODS A stratified convenience sample of 765 married and employed women was recruited during May to August 2010. Study variables of depression, socio-demographic threatening factors, psycho-stimulating factors, and social-role related factors were measured via a structured questionnaire. RESULTS Prevalence rate for depression was 18.6%, with highest rate (25.4%) from elementary laborers. Greater levels of depression were related to womens occupation, higher life stress, and poorer health; lower social support and vulnerable personality; higher levels of social-role related stress. From multivariate analysis, women with preadolescents were the most vulnerable to depression affected by occupation, life stress, personality, and parenting stress. These factors (except for occupational class) combined with economic status, social support, and housework unfairness were significant for depression in women with adolescents. CONCLUSION Depression among married and employed women differs by psycho-stimulating and social role relevant factors in addition to occupational class and family life cycle. Female elementary laborers and women with children need to have the highest prioritization for community mental health programs.

Effects of Breast Massage on Breast Pain, Breast-milk Sodium, and Newborn Suckling in Early Postpartum Mothers

PURPOSE In this study the effects of breast massage on breast pain, breast-milk sodium, and newborn suckling in early postpartum mothers were investigated. METHODS The design was a non-synchronized nonequivalent control group pretest-posttest design. Sixty postpartum mothers who were admitted to a postpartum care center and had problems with breastfeeding were recruited. Of these mothers, 44 were assigned to the intervention group and received two 30-minute breast massages within 10 days of postpartum period. The others were assigned control group and received only routine care. Breast pain was measured using a numeric pain scale and number of times newborns suckled was observed throughout breastfeeding. Breast milk was self-collected to evaluate breast-milk sodium. RESULTS Mean age of postpartum mothers was 30 years old. Compared to the control group, women in the intervention group reported significant decreases in breast pain (p<.001), increases in number of times newborns suckled after the first and second massage (p<.001), and a decrease in breast-milk sodium after the first massage (p=.034). CONCLUSION Breast massage may have effects on relieving breast pain, decreasing breast-milk sodium, and improving newborn suckling. Breast massage can be used to solve breast problems. Further research is needed to validate our findings.

A Structural Equation Model of Quality of Life in Adults with Type 2 Diabetes in Korea

PURPOSE The purpose of this study was to test a structural equation model in which self-efficacy and self-care activity predicts the quality of life (QOL) of individuals with type 2 diabetes in Korea. METHOD A survey about self-care activity, self-efficacy, glucose control, and QOL was completed by 132 diabetic patients from public health centers in Korea. Data were analyzed using SPSSWIN 18.0 and AMOS 19.0. RESULTS The mean age of the participants was 63.2 years. The proposed model was a good fit for the data based on the model fit indices. Self-efficacy had a significant effect on self-care activity (95%), and this model explained 25% of the variance in QOL. CONCLUSIONS The findings indicate that self-efficacy and self-care activity play important roles in explaining QOL in adults with type 2 diabetes. Nursing strategies to increase QOL in this population should contain self-efficacy enhancement to promote the performance of self-care activity.