PURPOSE: This study determined the level of stress and type of coping style of spouses with high-risk pregnant women. METHODS: Subjects were 102 spouses with high-risk pregnant women at 6 hospitals in Seoul and Gyeonggi province from January to August, 2009. The tools for this study were stress scale and coping scale. The data were analyzed by t-test, ANOVA, Scheffe's test and Pearson's correlation coefficient. RESULTS: The average score of subjects stress was 2.18 and coping score was 2.46 point out of 4.00. The highest score of stress categories was 2.44 point in emotional problems and the lowest score was 1.72 in communication and support resources. The stress level was significant differences according to length of marriage, number of hospital visits, satisfaction with marriage relationship, hospitalization days and gestational age respectively. Spouses tended to use an active coping style (2.60) rather than a passive coping style (2.31). There were significant differences according to mother's age and gestational age in active coping and educational level in passive coping. CONCLUSION: Considering the level of stress coping style and characteristics of high-risk pregnant women's spouses, a nursing intervention should be provided to help them alleviate stress and to encourage active coping.
Female ; Gestational Age ; Hospitalization ; Humans ; Marriage ; Pregnancy, High-Risk ; Pregnant Women ; Spouses ; Stress, Psychological

PURPOSE: This study determined the level of stress and type of coping style of spouses with high-risk pregnant women. METHODS: Subjects were 102 spouses with high-risk pregnant women at 6 hospitals in Seoul and Gyeonggi province from January to August, 2009. The tools for this study were stress scale and coping scale. The data were analyzed by t-test, ANOVA, Scheffe's test and Pearson's correlation coefficient. RESULTS: The average score of subjects stress was 2.18 and coping score was 2.46 point out of 4.00. The highest score of stress categories was 2.44 point in emotional problems and the lowest score was 1.72 in communication and support resources. The stress level was significant differences according to length of marriage, number of hospital visits, satisfaction with marriage relationship, hospitalization days and gestational age respectively. Spouses tended to use an active coping style (2.60) rather than a passive coping style (2.31). There were significant differences according to mother's age and gestational age in active coping and educational level in passive coping. CONCLUSION: Considering the level of stress coping style and characteristics of high-risk pregnant women's spouses, a nursing intervention should be provided to help them alleviate stress and to encourage active coping.
Female ; Gestational Age ; Hospitalization ; Humans ; Marriage ; Pregnancy, High-Risk ; Pregnant Women ; Spouses ; Stress, Psychological

Purpose: : The aim of this integrative review was to describe communication experiences and needs among the critically ill with an artificial airway and evaluate relevant intervention studies. Methods: : Using the method employed by Whittemore and Knafl (2005), we searched for papers on PubMed, CINAHL, and Web of Science published from January 1, 2015 to September 25, 2020. A total of 26 papers (11 descriptive studies, 15 experimental ones) were identified and evaluated. Results: : Communication experiences while having an artificial airway, identified either by patients’ recall or direct observation, were predominantly negative. However, positive experiences were reported in patients with improvements in physical conditions and functions. Patients’ communication needs were diverse, encompassing physical, psycho-emotional, social, spiritual, and medical issues. Interventions tested included alternative and augmentative communication strategies, communication intervention packages, and voice restorative devices. Physical, psychosocial, and communication-related patient outcomes were evaluated using various methods including self-report surveys, interviews, and observations. Conclusions : The findings from this review represent the state of science regarding communication of the critically ill whose vocal abilities are inhibited by the presence of an artificial airway. Future studies with rigorous experimental designs and measures are warranted to better understand and support the complex needs of this highly vulnerable patient population.

Purpose: : The aim of this integrative review was to describe communication experiences and needs among the critically ill with an artificial airway and evaluate relevant intervention studies. Methods: : Using the method employed by Whittemore and Knafl (2005), we searched for papers on PubMed, CINAHL, and Web of Science published from January 1, 2015 to September 25, 2020. A total of 26 papers (11 descriptive studies, 15 experimental ones) were identified and evaluated. Results: : Communication experiences while having an artificial airway, identified either by patients’ recall or direct observation, were predominantly negative. However, positive experiences were reported in patients with improvements in physical conditions and functions. Patients’ communication needs were diverse, encompassing physical, psycho-emotional, social, spiritual, and medical issues. Interventions tested included alternative and augmentative communication strategies, communication intervention packages, and voice restorative devices. Physical, psychosocial, and communication-related patient outcomes were evaluated using various methods including self-report surveys, interviews, and observations. Conclusions : The findings from this review represent the state of science regarding communication of the critically ill whose vocal abilities are inhibited by the presence of an artificial airway. Future studies with rigorous experimental designs and measures are warranted to better understand and support the complex needs of this highly vulnerable patient population.

Purpose: Premature infants have immature respiratory control and cerebral autoregulation. We aimed to investigate changes in cerebral oxygenation during apnea with and without peripheral oxygen desaturation in premature infants. Methods: This prospective observational study was conducted at Inha University Hospital. Near-infrared spectroscopy (NIRS)-monitored regional cerebral oxygen saturation (rScO2) and pulse oximeter-monitored peripheral oxygen saturation (SpO2) were assessed during the first week of life in 16 stable, spontaneously breathing preterm infants. Apneic episodes that lasted for ≥20 seconds or were accompanied by desaturation or bradycardia were included for analysis. The average rScO2 value during the 5-minute prior to apnea (baseline), the lowest rScO2 value following apnea (nadir), the time to recover to baseline (recovery time), the area under the curve (AUC), and the overshoot above the baseline after recovery were analyzed. Results: The median gestational age and birth weight of the infants were 29.2 weeks (interquartile range [IQR], 28.5 to 30.5) and 1,130 g (IQR, 985 to 1,245), respectively. A total of 73 apneic episodes were recorded at a median postnatal age of 2 days (IQR, 1 to 4). The rScO2 decreased significantly following apneic episodes regardless accompanied desaturation. There were no differences in baseline, nadir, or overshoot rScO2 between the two groups. However, the rScO2 AUC for apnea with desaturation was significantly higher than that for apnea without desaturation. Conclusion Cerebral oxygenation can significantly decrease during apnea, especially when accompanied by reduced SpO2. These results add the evidence for the clinical utility of NIRS in monitoring premature infants.

Purpose: Premature infants have immature respiratory control and cerebral autoregulation. We aimed to investigate changes in cerebral oxygenation during apnea with and without peripheral oxygen desaturation in premature infants. Methods: This prospective observational study was conducted at Inha University Hospital. Near-infrared spectroscopy (NIRS)-monitored regional cerebral oxygen saturation (rScO2) and pulse oximeter-monitored peripheral oxygen saturation (SpO2) were assessed during the first week of life in 16 stable, spontaneously breathing preterm infants. Apneic episodes that lasted for ≥20 seconds or were accompanied by desaturation or bradycardia were included for analysis. The average rScO2 value during the 5-minute prior to apnea (baseline), the lowest rScO2 value following apnea (nadir), the time to recover to baseline (recovery time), the area under the curve (AUC), and the overshoot above the baseline after recovery were analyzed. Results: The median gestational age and birth weight of the infants were 29.2 weeks (interquartile range [IQR], 28.5 to 30.5) and 1,130 g (IQR, 985 to 1,245), respectively. A total of 73 apneic episodes were recorded at a median postnatal age of 2 days (IQR, 1 to 4). The rScO2 decreased significantly following apneic episodes regardless accompanied desaturation. There were no differences in baseline, nadir, or overshoot rScO2 between the two groups. However, the rScO2 AUC for apnea with desaturation was significantly higher than that for apnea without desaturation. Conclusion Cerebral oxygenation can significantly decrease during apnea, especially when accompanied by reduced SpO2. These results add the evidence for the clinical utility of NIRS in monitoring premature infants.

A 55-year-old man with an implantable intrathecal drug delivery system (IDDS) implant removal surgery was performed to control a suspected implant infection. Clear discharge from a lumbar wound was detected after IDDS removal, but transcutaneous cerebral spinal fluid (CSF) leakage was not suspected because the patient did not suffer from a postural headache. Finally, a suspected CSF leakage was resolved with a single epidural blood patch.
Blood Patch, Epidural ; Drug Delivery Systems ; Headache ; Humans ; Middle Aged ; Neuralgia, Postherpetic ; Wounds and Injuries

Fetal lung development normally occurs in a hypoxic environment. Hypoxia-inducible factor (HIF)-1alpha is robustly induced under hypoxia and transactivates many genes that are essential for fetal development. Most preterm infants are prematurely exposed to hyperoxia, which can halt hypoxia-driven lung maturation. We were to investigate whether the HIF-1alpha inducer, deferoxamine (DFX) can improve alveolarization in a rat model of bronchopulmonary dysplasia (BPD). A rat model of BPD was produced by intra-amniotic lipopolysaccharide (LPS) administration and postnatal hyperoxia (85% for 7 days), and DFX (150 mg/kg/d) or vehicle was administered to rat pups intraperitoneally for 14 days. On day 14, the rat pups were sacrificed and their lungs were removed and examined. A parallel in vitro study was performed with a human small airway epithelial cell line to test whether DFX induces the expression of HIF-1alpha and its target genes. Alveolarization and pulmonary vascular development were impaired in rats with BPD. However, DFX significantly ameliorated these effects. Immunohistochemical analysis showed that HIF-1alpha was significantly upregulated in the lungs of BPD rats treated with DFX. DFX was also found to induce HIF-1alpha in human small airway epithelial cells and to promote the expression of HIF-1alpha target genes. Our data suggest that DFX induces and activates HIF-1alpha, thereby improving alveolarization and vascular distribution in the lungs of rats with BPD.
Animals ; Bronchopulmonary Dysplasia/*drug therapy/*metabolism/pathology ; Deferoxamine/*administration & dosage ; Female ; Hypoxia-Inducible Factor 1, alpha Subunit/*metabolism ; Male ; Pulmonary Alveoli/drug effects/*growth & development/metabolism/pathology ; Pulmonary Veins/drug effects/*growth & development/pathology ; Rats ; Rats, Sprague-Dawley ; Treatment Outcome ; Up-Regulation/drug effects

Hypoglycemia is one of the severe complications of diabetes. To prevent hypoglycemia, an emphasis is placed on maintaining an appropriate balance between nutrition, activity, and treatment, which can be achieved by the repetition of self-trials based on self-monitoring. Clinicians routinely focus on patients’ contribution, including timely intake of an adequate amount of carbohydrates, physical activity, antidiabetic medication, and abstinence from alcohol. Recently, many guidelines have highlighted the importance of clinicians’ factors and recommend individualized treatments according to lifestyle patterns and specific needs following the de-intensification of treatment. The optimal value of hemoglobin A1c (HbA1c) levels for blood glucose level regulation remains controversial among countries, but it generally does not exceed 8.0%. In populations that are at a risk of hypoglycemia, such as the older adults, it is advisable to adjust the target blood glucose level to less than 8.0%. Meanwhile, a blood glucose level of 7.0%–7.5% is generally recommended for healthy older adults. If the expected lifetime is shorter than 10 years or in patients with chronic kidney disease and severe cardiovascular disease, the HbA1c level target can be increased to 7.5%–8.0%. For even shorter lifetime expectancy, the target can be adjusted up to 8.0%–9.0%. To prevent hypoglycemia, the target blood glucose level needs to be adjusted, particularly in older adult patients. Ultimately, it is important to identify the maximum blood glucose levels that do not cause hypoglycemia and the minimum blood glucose levels that do not cause hyperglycemia-associated complications.

Being born small for gestational age (SGA) has been strongly associated with mortality during the perinatal period and long-term risk of metabolic syndrome, including type 2 diabetes mellitus, hypertension, hyperlipidemia, and coronary heart disease. Insulin resistance is an important factor in the development of metabolic syndrome in SGA, with several proposed hypotheses. Here, we report two cases of non-obese adolescent patients with early onset type 2 diabetes who were born SGA. Of these, one experienced catch-up growth, while the other did not. Both had a high body fat percentage at the time of diagnosis of type 2 diabetes and were diagnosed with fatty liver and hyperlipidemia before adolescence, at the age of 7 years. Early interventions for SGA are needed for healthy catch-up growth to prevent metabolic diseases in the future.