PURPOSE: The purpose of the study was to identify degrees of pain, menopause symptoms, and quality of life, and to identify factors influencing quality of life of patients with breast cancer who were on hormone therapy. METHODS: A cross-sectional survey design was utilized. Data were collected using questionnaires from 110 patients with breast cancer who had been on hormone therapy for 3 months or more and were being treated at a university hospital in Seoul. Data were analyzed using chi2-test, t-test, ANOVA, Pearson correlation coefficient and multiple linear regression. RESULTS: Mean age of the participants was 53.56 (SD=6.67) and 54 (51.4%) had stage 0 or I at the time of diagnosis. Most of the participants reported having pain and menopause symptoms (88.2% and 95.5% respectively). The mean score for quality of life was 87.84+/-21.17. Pain, menopause symptoms and quality of life had strong correlations with each other (p<.005). Quality of life was explained by menopause symptoms (beta= -.71), economic status (beta=.20) and occupation (beta=.16). CONCLUSION: The results of the study suggest that menopause symptoms should be incorporated into oncologic nursing care to improve quality of life of patients with breast cancer on hormone therapy.
Adult ; Aged ; Antineoplastic Agents, Hormonal/therapeutic use ; Breast Neoplasms/drug therapy/*psychology ; Cross-Sectional Studies ; Female ; Hospitals, University ; Hot Flashes ; Humans ; Middle Aged ; Pain Management ; Postmenopause ; *Quality of Life ; Questionnaires ; Socioeconomic Factors

PURPOSE: The study was aimed to investigate the levels of marital intimacy and quality of life (QOL) among women with breast cancer. METHODS: As a descriptive study, a total of 67 married women with breast cancer was recruited via convenient sampling from a breast clinic in an university hospital. A structured, self-reported questionnaire was administered to the participants. RESULTS: The most participants were housewives in their 40s and 50s, and were in high socioeconomic status. Two thirds of women perceived the marital intimacy with their spouse were increased after the diagnosis of breast cancer. Women's marital intimacy significantly differed by their levels of education. The level of cognitive intimacy was the highest among the subscales, whereas, sexual intimacy was the lowest. The family factor of QOL showed the highest score, and there were differences in QOL by employment status and cancer stage. The QOL and marital intimacy were not correlated significantly. CONCLUSION: Further research on the couples with breast cancer and intervention for increasing their marital intimacy are needed in the future.
Breast ; Breast Neoplasms ; Employment ; Family Characteristics ; Female ; Humans ; Marriage ; Quality of Life ; Surveys and Questionnaires ; Social Class ; Spouses

PURPOSE: The purpose of this study was to develop and validate of a knowledge scale for lymphedema in patients with breast cancer. METHODS: 34 preliminary items were made according to literature review, then verified content validity, construct validity, and reliability of the scale. 28 items among them were confirmed through content analysis by 4 experts. After a preliminary test, a survey for 156 breast cancer patients was performed for confirming construct validity and reliability. The data were analyzed using factor analysis, independent t-test, and KR-20. RESULTS: This scale had 28 items consisting of 2 categories: prevention and self-care of lymphedema. Construct validity was confirmed by known-group technique because there were some categories consisted of just one or two items, and some mismatches between categories and items in factor analysis. Women who were educated about lymphedema scored significantly higher than women who had not (t=-3.92, p<.001). Reliability was appropriate (KR-20=.81). A percentage of correct answers was 74.6%, but it was from 31.8% to 96.1%. CONCLUSION: The study shows that this scale is reliable and valid to measure the knowledge of lymphedema. This scale can be effective to assess and educate the patients with breast cancer.
Breast ; Breast Neoplasms ; Female ; Humans ; Lymphedema ; Nursing Methodology Research ; Reproducibility of Results ; Self Care

OBJECTIVES: We examined the association between the adherence to dietary guidelines for breast cancer survivors and health-related quality of life in a cross-sectional study of Korean breast cancer survivors. METHODS: A total of 157 women aged 21 to 79 years who had been diagnosed with stage I to III breast cancers according to the American Joint Committee on Cancer (AJCC) and had breast cancer surgery at least 6 months before the baseline were included. We used a Korean version of the Core 30 (C30) and Breast cancer 23 (BR23) module of the European Organization for Research and Treatment Cancer Quality of Life Questionnaire (EORTC-QLQ), both of which have been validated for Koreans. Participants were asked about their adherence to dietary guidelines for breast cancer survivors, suggested by the Korean breast cancer society, using a 5-point Likert scale. We summed dietary guideline adherence scores for each participant and calculated the least squares means of health-related quality of life according to dietary guideline adherence scores using the generalized linear model. RESULTS: Breast cancer survivors who had higher adherence to dietary guidelines for breast cancer survivors had lower constipation scores than those with lower adherence (p for trend=0.01). When we stratified by the stage at diagnosis, this association was limited to those who had been diagnosed with stage II or III breast cancers. Also, sexual functioning scores increased significantly with increasing adherence scores of dietary guidelines among those with stage II or III breast cancers (p for trend < 0.001). However, among those who had been diagnosed with stage I, higher scores of dietary guidelines were associated with higher scores of pain (p for trend=0.03) and breast symptoms (p for trend=0.05). CONCLUSIONS: Our study suggested that the health-related quality of life levels of breast cancer survivors are associated with the adherence to dietary guidelines and may differ by the stage of the breast cancer.
Breast ; Breast Neoplasms* ; Constipation ; Cross-Sectional Studies ; Diagnosis ; Female ; Humans ; Joints ; Least-Squares Analysis ; Linear Models ; Nutrition Policy* ; Quality of Life* ; Surveys and Questionnaires ; Survivors*

This survey of 836 midlife women (51.0 +/- 4.0 yrs) was undertaken by exclusively a face to face interview by well-trained interviewers guarantying data collection of higher quality. This survey data was analyzed using the SPSS program. The main purpose of this study was to describe the factors affecting self-rated health status, including dietary habits and physical . mental . social factors. In the self-rated health status of a 'good' group, age was lower (p < 0.05), monthly income was higher (p < 0.01), dietary habits score (p < 0.001) and appetite (p < 0.001) and the degree of movement (p < 0.001) and life satisfaction (p < 0.001), marital intimacy (p < 0.001) and relationship satisfaction with their children (p < 0.001) were significantly higher than the 'bad' group. The level of depression (p < 0.001) and severe feeling of menopausal symptoms (p < 0.001) were significantly higher in the 'poor' group. The results of correlation analysis demonstrated that educational level (r = 0.069, p < 0.05),income (r = 0.157, p < 0.001), eating habits (r = 0.235, p < 0.001), appetite (r = 0.263, p < 0.001), life satisfaction (r = 0.197, p < 0.001), marital intimacy (r = 0.167, p < 0.001), child relationship satisfaction (r = 0.149, p < 0.001), positive attitude toward menopause (r = 0.070, p < 0.05) showed a positive correlation, but depression (r = -0.122, p < 0.001) and menopausal symptoms (r = -0.292, p < 0.001) showed a negative association with self-rated health status. The predictable factors affecting the self-rated health status of middle-aged women were examined by multiple regression analysis. The 'menopausal symptoms - physical discomfort' was the most important variables followed by the 'appetite', 'eating habits', 'menopause symptoms - sensory problems', 'BMI', 'positive attitude toward menopause' and 'high marital intimacy'. These results showed that the 'appetite' and 'eating habits' are important factors affecting the self-rated health status. Therefore, a program of dietary education must be considered for the effective health education and counseling of middle-aged women.
Appetite ; Child ; Counseling ; Surveys and Questionnaires ; Depression ; Eating ; Female ; Food Habits ; Health Education ; Health Status ; Humans ; Menopause ; Women's Health

OBJECTIVES: We aimed to evaluate dietary intake among female breast cancer survivors in a cross-sectional study. METHODS: A total of 127 women who had breast cancer surgery at least 6 months before baseline were included. Dietary intake of female breast cancer survivors was assessed through self-reported 3 day-dietary records. To compare dietary intake between breast cancer survivors and general female population without cancer, we selected the 1:4 age matched women from the 2011 Korean National Health and Nutrition Examination Survey (KNHANES). In the KNHANES, participants were asked about their dietary intake using the 24-hour dietary recalls. We also examined whether dietary intake varied by age group, cancer stage, or time since surgery among breast cancer survivors. We used the generalized linear model to compare their dietary intakes. RESULTS: Intakes of total energy, beta-carotene, folate, vitamin C, plant iron and fruits were lower among breast cancer survivors with longer time since surgery compared to those with shorter time (p < 0.05). Breast cancer patients with higher stage at diagnosis tended to consume less legumes (p = 0.01) than those with lower stage. When we compared dietary intake between breast cancer survivors and the general female population without cancer, breast cancer survivors were more likely to consume most of macro- and micro-nutrients in larger quantity (p < 0.05) and adhere to healthier diet characterized by higher intakes of legumes, seed and nuts, vegetables and fishes and shells than the general female population who never had been diagnosed with cancer (p < 0.05). CONCLUSIONS: Our study results suggested that the intakes of nutrients and foods varied by time since surgery and cancer stage among breast cancer survivors and dietary intakes among breast cancer survivors differed from that in the general population. Further prospective studies are warranted to explore the association between dietary intakes of specific food items and survival among Korean breast cancer survivors.
Ascorbic Acid ; beta Carotene ; Breast Neoplasms* ; Cross-Sectional Studies ; Diagnosis ; Diet ; Fabaceae ; Female ; Fishes ; Folic Acid ; Fruit ; Humans ; Iron ; Linear Models ; Nutrition Surveys ; Nuts ; Plants ; Survivors* ; Vegetables

Thrombotic thrombocytopenic purpura (TTP) is a clinical syndrome characterized by micro-angiopathic hemolytic anemia, thrombocytopenia, fever, renal disorders, and neurological manifestations. Its clinical course is rapid and the mortality rate is high if untreated or relapse occurs. Previous studies reported that rituximab, a monoclonal antibody for CD20 surface antigen on B lymphocytes, may be effective in treating idiopathic TTP that is refractory to plasma exchange or relapses after remission. A 27-year-old Vietnamese man presented with fever and fatigue starting 3 days earlier, which was diagnosed as idiopathic TTP. To overcome his poor responsiveness to combined therapy using steroids and plasma exchange, rituximab was considered. In the current case, the patient was treated with a lower dose of rituximab, instead of the conventional 375 mg/m2/week, and achieved successful remission.
Adult ; Anemia, Hemolytic ; Antigens, Surface ; Asian Continental Ancestry Group ; B-Lymphocytes ; Fatigue ; Fever ; Glucocorticoids ; Humans ; Mortality ; Neurologic Manifestations ; Plasma Exchange ; Plasma* ; Purpura, Thrombotic Thrombocytopenic* ; Recurrence ; Steroids ; Thrombocytopenia ; Thrombotic Microangiopathies ; Rituximab

Background: Nationwide research on the association between carbapenem-resistant Enterobacterales (CREs) and antibiotic use is limited. Methods: This nested case-control study analyzed Korean National Health Insurance claims data from April 2017 to April 2019. Based on the occurrence of CRE, hospitalized patients aged ≥ 18 years were classified into CRE (cases) and control groups. Propensity scores based on age, sex, modified Charlson comorbidity score, insurance type, long-term care facility, intensive care unit stay, and acquisition of vancomycin-resistant Enterococci were used to match the case and control groups (1:3). Results: After matching, the study included 6,476 participants (1,619 cases and 4,857 controls).Multivariable logistic regression analysis revealed that the utilization of broad-spectrum antibiotics, such as piperacillin/tazobactam (adjusted odds ratio [aOR], 2.178; 95% confidence interval [CI], 1.829–2.594), third/fourth generation cephalosporins (aOR, 1.764; 95% CI, 1.514–2.056), and carbapenems (aOR, 1.775; 95% CI, 1.454–2.165), as well as the presence of comorbidities (diabetes [aOR, 1.237; 95% CI, 1.061–1.443], hemiplegia or paraplegia [aOR, 1.370; 95% CI, 1.119–1.679], kidney disease [aOR, 1.312; 95% CI, 1.105–1.559], and liver disease [aOR, 1.431; 95% CI, 1.073–1.908]), were significantly associated with the development of CRE.Additionally, the CRE group had higher mortality (8.33 vs. 3.32 incidence rate per 100 personmonths, P < 0.001) and a total cost of healthcare utilization per person-month (15,325,491 ± 23,587,378 vs. 5,263,373 ± 14,070,118 KRW, P < 0.001) than the control group. Conclusion The utilization of broad-spectrum antibiotics and the presence of comorbidities are associated with increasing development of CRE. This study emphasizes the importance of antimicrobial stewardship in reducing broad-spectrum antibiotic use and CRE disease burden in Korea.

Objective: This study aimed to explore the myelin volume change in patients with mild traumatic brain injury (mTBI) with post-concussion syndrome (PCS) using a multidynamic multiecho (MDME) sequence and automatic whole-brain segmentation. Materials and Methods: Forty-one consecutive mTBI patients with PCS and 29 controls, who had undergone MRI including the MDME sequence between October 2016 and April 2018, were included. Myelin volume fraction (MVF) maps were derived from the MDME sequence. After three dimensional T1-based brain segmentation, the average MVF was analyzed at the bilateral cerebral white matter (WM), bilateral cerebral gray matter (GM), corpus callosum, and brainstem. The Mann–Whitney U-test was performed to compare MVF and myelin volume between patients with mTBI and controls. Myelin volume was correlated with neuropsychological test scores using the Spearman rank correlation test. Results: The average MVF at the bilateral cerebral WM was lower in mTBI patients with PCS (median [interquartile range], 25.2% [22.6%–26.4%]) than that in controls (26.8% [25.6%–27.8%]) (p = 0.004). The region-of-interest myelin volume was lower in mTBI patients with PCS than that in controls at the corpus callosum (1.87 cm3 [1.70–2.05 cm3 ] vs. 2.21 cm3 [1.86– 3.46 cm3 ]; p = 0.003) and brainstem (9.98 cm3 [9.45–11.00 cm3 ] vs. 11.05 cm3 [10.10–11.53 cm3 ]; p = 0.015). The total myelin volume was lower in mTBI patients with PCS than that in controls at the corpus callosum (0.45 cm3 [0.39–0.48 cm3 ] vs. 0.48 cm3 [0.45–0.54 cm3 ]; p = 0.004) and brainstem (1.45 cm3 [1.28–1.59 cm3 ] vs. 1.54 cm3 [1.42–1.67 cm3 ]; p = 0.042). No significant correlation was observed between myelin volume parameters and neuropsychological test scores, except for the total myelin volume at the bilateral cerebral WM and verbal learning test (delayed recall) (r = 0.425; p = 0.048). Conclusion MVF quantified from the MDME sequence was decreased at the bilateral cerebral WM in mTBI patients with PCS. The total myelin volumes at the corpus callosum and brainstem were decreased in mTBI patients with PCS due to atrophic changes.

Objective: This study aimed to investigate the blood-brain barrier (BBB) disruption in mild traumatic brain injury (mTBI) patients with post-concussion syndrome (PCS) using dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging and automatic whole brain segmentation. Materials and Methods: Forty-two consecutive mTBI patients with PCS who had undergone post-traumatic MR imaging, including DCE MR imaging, between October 2016 and April 2018, and 29 controls with DCE MR imaging were included in this retrospective study. After performing three-dimensional T1-based brain segmentation with FreeSurfer software (Laboratory for Computational Neuroimaging), the mean Ktrans and vp from DCE MR imaging (derived using the Patlak model and extended Tofts and Kermode model) were analyzed in the bilateral cerebral/cerebellar cortex, bilateral cerebral/cerebellar white matter (WM), and brainstem. Ktrans values of the mTBI patients and controls were calculated using both models to identify the model that better reflected the increased permeability owing to mTBI (tendency toward higher Ktrans values in mTBI patients than in controls). The Mann-Whitney U test and Spearman rank correlation test were performed to compare the mean Ktrans and vp between the two groups and correlate Ktrans and vp with neuropsychological tests for mTBI patients. Results: Increased permeability owing to mTBI was observed in the Patlak model but not in the extended Tofts and Kermode model. In the Patlak model, the mean Ktrans in the bilateral cerebral cortex was significantly higher in mTBI patients than in controls (p = 0.042). The mean vp values in the bilateral cerebellar WM and brainstem were significantly lower in mTBI patients than in controls (p = 0.009 and p = 0.011, respectively). The mean Ktrans of the bilateral cerebral cortex was significantly higher in patients with atypical performance in the auditory continuous performance test (commission errors) than in average or good performers (p = 0.041). Conclusion BBB disruption, as reflected by the increased Ktrans and decreased vp values from the Patlak model, was observed throughout the bilateral cerebral cortex, bilateral cerebellar WM, and brainstem in mTBI patients with PCS.